Provider Demographics
NPI:1063567477
Name:ADVANCED NEUROLOGICAL EVALUATION AND TREATMENT CENTER PC
Entity type:Organization
Organization Name:ADVANCED NEUROLOGICAL EVALUATION AND TREATMENT CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/AUTHORIZED OFFICIAL
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:
Authorized Official - Last Name:FELDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-863-0501
Mailing Address - Street 1:1601 E 19TH AVE STE 4400
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80218-1253
Mailing Address - Country:US
Mailing Address - Phone:303-863-0501
Mailing Address - Fax:303-863-0497
Practice Address - Street 1:1601 E 19TH AVE STE 4400
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-1253
Practice Address - Country:US
Practice Address - Phone:303-863-0501
Practice Address - Fax:303-863-0497
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2022-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO37088769Medicaid
CO504368Medicare ID - Type UnspecifiedGROUP NUMBER