Provider Demographics
NPI:1902237324
Name:NEUROLOGY OF SUGAR LAND
Entity type:Organization
Organization Name:NEUROLOGY OF SUGAR LAND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:IRENA
Authorized Official - Middle Name:
Authorized Official - Last Name:PANKIEWICZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-937-7653
Mailing Address - Street 1:15200 SOUTHWEST FWY
Mailing Address - Street 2:SUITE 395
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-3845
Mailing Address - Country:US
Mailing Address - Phone:281-937-7653
Mailing Address - Fax:281-937-7062
Practice Address - Street 1:15200 SOUTHWEST FWY
Practice Address - Street 2:SUITE 395
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-3845
Practice Address - Country:US
Practice Address - Phone:281-937-7653
Practice Address - Fax:281-937-7062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-11
Last Update Date:2014-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK16072084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX344560Medicare PIN