Provider Demographics
NPI:1295914604
Name:NEUROLOGICAL INSTITUTE, PA
Entity type:Organization
Organization Name:NEUROLOGICAL INSTITUTE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KHIZAR
Authorized Official - Middle Name:
Authorized Official - Last Name:MALIK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-350-4804
Mailing Address - Street 1:7557 W SAND LAKE RD
Mailing Address - Street 2:PMB 102
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-5109
Mailing Address - Country:US
Mailing Address - Phone:407-350-4804
Mailing Address - Fax:407-483-8941
Practice Address - Street 1:407 W OAK ST
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-4931
Practice Address - Country:US
Practice Address - Phone:407-350-4804
Practice Address - Fax:407-483-8941
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-01
Last Update Date:2014-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME88150174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK4715Medicare PIN