Provider Demographics
NPI:1124263660
Name:BRAIN AND SPINE NEUROSUGERY,LLC
Entity type:Organization
Organization Name:BRAIN AND SPINE NEUROSUGERY,LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:YONAS
Authorized Official - Middle Name:
Authorized Official - Last Name:ZEGEYE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:772-220-9700
Mailing Address - Street 1:1050 SE MONTEREY RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-4512
Mailing Address - Country:US
Mailing Address - Phone:772-220-9700
Mailing Address - Fax:772-219-8196
Practice Address - Street 1:1050 SE MONTEREY RD
Practice Address - Street 2:SUITE 102
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-4512
Practice Address - Country:US
Practice Address - Phone:772-220-9700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-12
Last Update Date:2008-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical