Provider Demographics
NPI:1699986711
Name:NEUROLOGY AND PAIN MANAGEMENT, P.A.
Entity type:Organization
Organization Name:NEUROLOGY AND PAIN MANAGEMENT, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:ALLA
Authorized Official - Middle Name:
Authorized Official - Last Name:MESH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-218-9898
Mailing Address - Street 1:163 ELM ST
Mailing Address - Street 2:
Mailing Address - City:TENAFLY
Mailing Address - State:NJ
Mailing Address - Zip Code:07670-3032
Mailing Address - Country:US
Mailing Address - Phone:917-359-8378
Mailing Address - Fax:
Practice Address - Street 1:87 BERDAN AVE
Practice Address - Street 2:SUITE B2
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-3210
Practice Address - Country:US
Practice Address - Phone:973-692-9631
Practice Address - Fax:973-692-7778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY208981174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJP3611393OtherOXFORD NJ
NY0068292Medicaid
NY3953580OtherCIGNA
NY2060979Medicaid
NY3099034OtherGHI PPO
NY7675051OtherAETNA
NY606N01OtherBLUE CROSS BLUE SHEILD
NY0068292Medicaid
NY2060979Medicaid
NJP3611393OtherOXFORD NJ
NY606N01OtherBLUE CROSS BLUE SHEILD