Provider Demographics
NPI:1407723554
Name:NEUROGLOW P.C.
Entity type:Organization
Organization Name:NEUROGLOW P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:MOMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAFARULLAH
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:210-862-4199
Mailing Address - Street 1:4961 LONG PRAIRIE RD
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028-2793
Mailing Address - Country:US
Mailing Address - Phone:800-975-3859
Mailing Address - Fax:
Practice Address - Street 1:4961 LONG PRAIRIE RD
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-2793
Practice Address - Country:US
Practice Address - Phone:800-975-3859
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-22
Last Update Date:2025-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)