Provider Demographics
NPI:1124071709
Name:NORTHEAST NEUROSURGERY LLC
Entity type:Organization
Organization Name:NORTHEAST NEUROSURGERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:HRUSTICH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:518-446-1850
Mailing Address - Street 1:63 SHAKER RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12204-1030
Mailing Address - Country:US
Mailing Address - Phone:518-446-1850
Mailing Address - Fax:518-446-1861
Practice Address - Street 1:63 SHAKER RD
Practice Address - Street 2:SUITE 201
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12204-1030
Practice Address - Country:US
Practice Address - Phone:518-446-1850
Practice Address - Fax:518-446-1861
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty