Provider Demographics
NPI:1811160534
Name:ABK NEUROLOGICAL ASSOCIATES P C
Entity type:Organization
Organization Name:ABK NEUROLOGICAL ASSOCIATES P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NEUROLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JAGGA
Authorized Official - Middle Name:RAO
Authorized Official - Last Name:ALLURI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-268-1458
Mailing Address - Street 1:11050 71ST RD
Mailing Address - Street 2:STE 1B
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-4969
Mailing Address - Country:US
Mailing Address - Phone:718-268-1458
Mailing Address - Fax:718-268-1471
Practice Address - Street 1:11050 71ST RD
Practice Address - Street 2:STE 1B
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-4969
Practice Address - Country:US
Practice Address - Phone:718-268-1458
Practice Address - Fax:718-268-1471
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-03
Last Update Date:2015-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY197909174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02110007Medicaid
NY02110007Medicaid