Provider Demographics
NPI:1831375674
Name:NEUROLOGY AND PAIN MANAGEMENT PLLC
Entity type:Organization
Organization Name:NEUROLOGY AND PAIN MANAGEMENT PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALLA
Authorized Official - Middle Name:
Authorized Official - Last Name:MESH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-359-8378
Mailing Address - Street 1:163 ELM ST
Mailing Address - Street 2:
Mailing Address - City:TENAFLY
Mailing Address - State:NJ
Mailing Address - Zip Code:07670-3032
Mailing Address - Country:US
Mailing Address - Phone:917-359-8378
Mailing Address - Fax:718-625-2155
Practice Address - Street 1:258 HENRY ST
Practice Address - Street 2:UNIT A
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-4664
Practice Address - Country:US
Practice Address - Phone:718-625-2123
Practice Address - Fax:718-625-2155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-10
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY208981OtherLISENCE
NY208981OtherLISENCE