Provider Demographics
NPI:1952587313
Name:BAYAMON NEUROLOGY SERVICES, PSC
Entity Type:Organization
Organization Name:BAYAMON NEUROLOGY SERVICES, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAIME
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-740-7123
Mailing Address - Street 1:BAYAMON MEDICAL PLAZA AVE #2
Mailing Address - Street 2:906
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00961
Mailing Address - Country:US
Mailing Address - Phone:787-740-7123
Mailing Address - Fax:787-785-1153
Practice Address - Street 1:BAYAMON MEDICAL PLAZA AVE #2
Practice Address - Street 2:906
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961
Practice Address - Country:US
Practice Address - Phone:787-740-7123
Practice Address - Fax:787-785-1153
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-16
Last Update Date:2012-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13531261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRH82119Medicare UPIN