Provider Demographics
NPI:1285057091
Name:DEVELOPMENTAL NEUROLOGICAL EVALUATIONS AND TREATMENT
Entity type:Organization
Organization Name:DEVELOPMENTAL NEUROLOGICAL EVALUATIONS AND TREATMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAVINDER
Authorized Official - Middle Name:
Authorized Official - Last Name:TIKOO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-536-8940
Mailing Address - Street 1:1 FULTON AVE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11550-3646
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1 FULTON AVE
Practice Address - Street 2:SUITE 120
Practice Address - City:HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11550-3646
Practice Address - Country:US
Practice Address - Phone:646-349-3883
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-30
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1982522084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty