Provider Demographics
NPI:1285084251
Name:WELL CARE NEUROLOGY PLLC
Entity type:Organization
Organization Name:WELL CARE NEUROLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VIKAS
Authorized Official - Middle Name:
Authorized Official - Last Name:AGRAWAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-386-8964
Mailing Address - Street 1:18 SYLVIA AVE
Mailing Address - Street 2:
Mailing Address - City:ARDSLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10502-1109
Mailing Address - Country:US
Mailing Address - Phone:917-386-8964
Mailing Address - Fax:
Practice Address - Street 1:1665 GRAND CONCOURSE
Practice Address - Street 2:SUITE A
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10452-5815
Practice Address - Country:US
Practice Address - Phone:917-386-8964
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-20
Last Update Date:2016-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2731402084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty