Provider Demographics
NPI:1104107697
Name:NEUROLOGICMD P.S.C.
Entity type:Organization
Organization Name:NEUROLOGICMD P.S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIUD
Authorized Official - Middle Name:
Authorized Official - Last Name:IRIZARRY CLAUDIO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-772-5555
Mailing Address - Street 1:AVE JESUS T PINERO # 282
Mailing Address - Street 2:EDIFICIO PLAZA EL AMAL SUITE 210
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918-4003
Mailing Address - Country:US
Mailing Address - Phone:787-772-5555
Mailing Address - Fax:787-772-3535
Practice Address - Street 1:AVE JESUS T PINERO # 282
Practice Address - Street 2:EDIFICIO PLAZA EL AMAL SUITE 210
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-4003
Practice Address - Country:US
Practice Address - Phone:787-772-5555
Practice Address - Fax:787-772-3535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-29
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16446261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR002-8717Medicare UPIN