MEDICARE: PENNSYLVANIA INSTITUTE OF NEUROLOGY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084N0400X	Neurology Physician	MD436858	PA

General Provider Information

NPI Number	:	1194054460
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PENNSYLVANIA INSTITUTE OF NEUROLOGY LLC

Provider Business Mailing Address
First Line	:	PO BOX 30
Second Line	:	3045 N SUSQUEHANNA TRAIL
City	:	SHAMOKIN DAM
State	:	PA
Zip	:	17876-0030
Country	:	US
Telephone Number	:	570-884-3243
Fax Number	:	570-884-3246

Provider Business Practice Location Address
First Line	:	113 N MARKET ST
Second Line	:	STE D
City	:	SELINSGROVE
State	:	PA
Zip	:	17870-1941
Country	:	US
Telephone Number	:	570-884-3243
Fax Number	:	570-884-3246

Authorized Official
Title or Position	:	PRESIDENT
Name	:	HASAN ASKARI
Credential	:	MD
Telephone Number	:	570-884-3243

Provider Enumeration Date	:	12/16/2009
Last Update Date	:	12/16/2009

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