Provider Demographics
NPI:1194054460
Name:PENNSYLVANIA INSTITUTE OF NEUROLOGY LLC
Entity type:Organization
Organization Name:PENNSYLVANIA INSTITUTE OF NEUROLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HASAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ASKARI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:570-884-3243
Mailing Address - Street 1:PO BOX 30
Mailing Address - Street 2:3045 N SUSQUEHANNA TRAIL
Mailing Address - City:SHAMOKIN DAM
Mailing Address - State:PA
Mailing Address - Zip Code:17876-0030
Mailing Address - Country:US
Mailing Address - Phone:570-884-3243
Mailing Address - Fax:570-884-3246
Practice Address - Street 1:113 N MARKET ST
Practice Address - Street 2:STE D
Practice Address - City:SELINSGROVE
Practice Address - State:PA
Practice Address - Zip Code:17870-1941
Practice Address - Country:US
Practice Address - Phone:570-884-3243
Practice Address - Fax:570-884-3246
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-16
Last Update Date:2009-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4368582084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty