Provider Demographics
NPI:1699953810
Name:INTEGRATED NEUROLOGY SERVICES
Entity type:Organization
Organization Name:INTEGRATED NEUROLOGY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SIMON
Authorized Official - Middle Name:
Authorized Official - Last Name:FISHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-313-9111
Mailing Address - Street 1:6355 WALKER LN STE 313
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22310-3258
Mailing Address - Country:US
Mailing Address - Phone:703-313-9111
Mailing Address - Fax:703-313-4945
Practice Address - Street 1:6355 WALKER LN STE 313
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22310-3258
Practice Address - Country:US
Practice Address - Phone:703-313-9111
Practice Address - Fax:703-313-4945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-11
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101225797261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCG01414Medicare PIN