Provider Demographics
NPI:1336858232
Name:NEUROGLEE CARE PLLC
Entity type:Organization
Organization Name:NEUROGLEE CARE PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RAVI
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:352-313-8000
Mailing Address - Street 1:101 ARCH ST FL 8
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02110-7500
Mailing Address - Country:US
Mailing Address - Phone:857-557-5777
Mailing Address - Fax:857-557-5778
Practice Address - Street 1:221 1ST AVE SW STE 610
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55902-4504
Practice Address - Country:US
Practice Address - Phone:857-557-5777
Practice Address - Fax:857-557-5778
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEUROGLEE CARE PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-11-18
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty