Provider Demographics
NPI:1801883798
Name:NEUROLOGY ASSOCIATES, INC.
Entity type:Organization
Organization Name:NEUROLOGY ASSOCIATES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:A
Authorized Official - Last Name:FABER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-725-2010
Mailing Address - Street 1:3009 N BALLAS RD
Mailing Address - Street 2:SUITE 102B
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63131-2322
Mailing Address - Country:US
Mailing Address - Phone:314-725-2010
Mailing Address - Fax:314-725-0709
Practice Address - Street 1:3009 N BALLAS RD
Practice Address - Street 2:SUITE 102B
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63131-2322
Practice Address - Country:US
Practice Address - Phone:314-725-2010
Practice Address - Fax:314-725-0709
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-05
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO11629OtherESSENCE
IL9522186OtherBCBS
MO508269107Medicaid
MO508269107Medicaid
MO000012262Medicare PIN
MO11629OtherESSENCE