Provider Demographics
NPI:1699059451
Name:ADVANCED NEUROLOGY PC
Entity type:Organization
Organization Name:ADVANCED NEUROLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:IRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:KOGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-676-0111
Mailing Address - Street 1:445 KINGS HIGHWAY
Mailing Address - Street 2:2 FLOOR
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-1780
Mailing Address - Country:US
Mailing Address - Phone:718-676-0111
Mailing Address - Fax:718-676-9710
Practice Address - Street 1:445 KINGS HWY
Practice Address - Street 2:2 FLOOR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-1780
Practice Address - Country:US
Practice Address - Phone:718-676-0111
Practice Address - Fax:718-676-9710
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-28
Last Update Date:2014-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty