Provider Demographics
NPI:1427245075
Name:ADVANCED NEUROLOGICAL CARE P.C.
Entity type:Organization
Organization Name:ADVANCED NEUROLOGICAL CARE P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KERIN
Authorized Official - Middle Name:BELLER
Authorized Official - Last Name:HAUSKNECHT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-374-4451
Mailing Address - Street 1:PO BOX 209
Mailing Address - Street 2:
Mailing Address - City:HEWLETT
Mailing Address - State:NY
Mailing Address - Zip Code:11557-0209
Mailing Address - Country:US
Mailing Address - Phone:516-374-4451
Mailing Address - Fax:516-374-1987
Practice Address - Street 1:23 LANGDON PL
Practice Address - Street 2:
Practice Address - City:LYNBROOK
Practice Address - State:NY
Practice Address - Zip Code:11563-2414
Practice Address - Country:US
Practice Address - Phone:516-374-4451
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-27
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY202181204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMMGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01895638Medicaid
NYG100065191Medicare PIN
NYA100063931Medicare PIN
NY01895638Medicaid