Provider Demographics
NPI:1700077732
Name:SMIRNOFF NEUROLOGY PA
Entity Type:Organization
Organization Name:SMIRNOFF NEUROLOGY PA
Other - Org Name:VILLAGE NEUROLOGY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:H
Authorized Official - Last Name:SMIRNOFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-633-2164
Mailing Address - Street 1:1576 BELLA CRUZ DR
Mailing Address - Street 2:PMB 413
Mailing Address - City:THE VILLAGES
Mailing Address - State:FL
Mailing Address - Zip Code:32159-8969
Mailing Address - Country:US
Mailing Address - Phone:352-633-2164
Mailing Address - Fax:352-205-8149
Practice Address - Street 1:729 CR 466
Practice Address - Street 2:
Practice Address - City:LADY LAKE
Practice Address - State:FL
Practice Address - Zip Code:32159
Practice Address - Country:US
Practice Address - Phone:352-633-2164
Practice Address - Fax:352-205-8149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-06
Last Update Date:2015-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1062362084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALH58686Medicare UPIN