Provider Demographics
NPI:1831975309
Name:NEUROLOGIC CENTER FOR EPILEPSY, LLC
Entity type:Organization
Organization Name:NEUROLOGIC CENTER FOR EPILEPSY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PREETI
Authorized Official - Middle Name:
Authorized Official - Last Name:GUPTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:401-781-2400
Mailing Address - Street 1:375 WAMPANOAG TRL STE 405B
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:RI
Mailing Address - Zip Code:02915-2232
Mailing Address - Country:US
Mailing Address - Phone:401-781-2400
Mailing Address - Fax:401-526-9517
Practice Address - Street 1:375 WAMPANOAG TRL STE 405B
Practice Address - Street 2:
Practice Address - City:EAST PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02915
Practice Address - Country:US
Practice Address - Phone:401-781-2400
Practice Address - Fax:401-526-9517
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-31
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty