Provider Demographics
NPI:1902522782
Name:CRESCENT COAST NEUROLOGY, L.L.C.
Entity type:Organization
Organization Name:CRESCENT COAST NEUROLOGY, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:AHSAN
Authorized Official - Middle Name:ZAKI
Authorized Official - Last Name:NIAZI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:321-636-8366
Mailing Address - Street 1:1910 ROCKLEDGE BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-3751
Mailing Address - Country:US
Mailing Address - Phone:321-636-8366
Mailing Address - Fax:321-636-3985
Practice Address - Street 1:1910 ROCKLEDGE BLVD STE 101
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-3751
Practice Address - Country:US
Practice Address - Phone:321-636-8366
Practice Address - Fax:321-636-3985
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-13
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty