Provider Demographics
NPI:1104254655
Name:NEUROLOGIX DIAGNOSTIC SERVICES, LLC
Entity type:Organization
Organization Name:NEUROLOGIX DIAGNOSTIC SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LEONARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:ROLLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:321-320-9601
Mailing Address - Street 1:2415 S VOLUSIA AVE STE A2
Mailing Address - Street 2:
Mailing Address - City:ORANGE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32763-7623
Mailing Address - Country:US
Mailing Address - Phone:386-775-6879
Mailing Address - Fax:
Practice Address - Street 1:940 CENTRE CIR STE 1018
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32714-7242
Practice Address - Country:US
Practice Address - Phone:321-320-9601
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-20
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Multi-Specialty
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty