Provider Demographics
NPI:1427367101
Name:NORTH SHORE NEUROLOGICAL ASSOCIATES, INC.
Entity type:Organization
Organization Name:NORTH SHORE NEUROLOGICAL ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:S
Authorized Official - Last Name:LEVITSKY
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:978-532-1730
Mailing Address - Street 1:6 ESSEX CENTER DR
Mailing Address - Street 2:SUITE 303
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960-2963
Mailing Address - Country:US
Mailing Address - Phone:978-532-1730
Mailing Address - Fax:978-532-5331
Practice Address - Street 1:6 ESSEX CENTER DR
Practice Address - Street 2:SUITE 303
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-2963
Practice Address - Country:US
Practice Address - Phone:978-532-1730
Practice Address - Fax:978-532-5331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-29
Last Update Date:2010-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAXL4079869207RA0401X
MA267732084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
No207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MANX4108Medicare UPIN