Provider Demographics
NPI:1770522724
Name:TRISTATE NEUROLOGICAL SURGEONS, P.C.
Entity type:Organization
Organization Name:TRISTATE NEUROLOGICAL SURGEONS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY LYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:ANGELOTTI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-459-1013
Mailing Address - Street 1:120 E 2ND ST
Mailing Address - Street 2:SUITE 401
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16507-1537
Mailing Address - Country:US
Mailing Address - Phone:814-459-1013
Mailing Address - Fax:814-459-0435
Practice Address - Street 1:120 E 2ND ST
Practice Address - Street 2:SUITE 401
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16507-1537
Practice Address - Country:US
Practice Address - Phone:814-459-1013
Practice Address - Fax:814-459-0435
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-05
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001043Medicare ID - Type Unspecified
PA1247290001Medicare NSC