Provider Demographics
NPI:1063948560
Name:INSTITUTE OF PEDIATRIC NEUROSCIENCES
Entity type:Organization
Organization Name:INSTITUTE OF PEDIATRIC NEUROSCIENCES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EDGARD
Authorized Official - Middle Name:O
Authorized Official - Last Name:ANDRADE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-260-7346
Mailing Address - Street 1:1315 SE 25TH LOOP
Mailing Address - Street 2:UNIT 104
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-1030
Mailing Address - Country:US
Mailing Address - Phone:352-260-7343
Mailing Address - Fax:
Practice Address - Street 1:1315 SE 25TH LOOP
Practice Address - Street 2:UNIT 104
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-1030
Practice Address - Country:US
Practice Address - Phone:352-260-7343
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-04
Last Update Date:2017-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty