MEDICARE: YOUNGSTOWN NEUROLOGIC ASSOCIATES

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	225100000X	Physical Therapist	PT-09049	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000104951	OTHER	OH	UNISON #
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	0034184	OTHER	OH	CHAMPUS #
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1336279132
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YOUNGSTOWN NEUROLOGIC ASSOCIATES

Provider Business Mailing Address
First Line	:	1616 COVINGTON ST
Second Line	:
City	:	YOUNGSTOWN
State	:	OH
Zip	:	44510-1244
Country	:	US
Telephone Number	:	330-747-9215
Fax Number	:	330-747-9248

Provider Business Practice Location Address
First Line	:	1616 COVINGTON ST
Second Line	:
City	:	YOUNGSTOWN
State	:	OH
Zip	:	44510-1244
Country	:	US
Telephone Number	:	330-747-9215
Fax Number	:	330-747-9248

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. BRIAN P BROCKER
Credential	:	M.D.
Telephone Number	:	330-747-9215

Provider Enumeration Date	:	03/07/2007
Last Update Date	:	08/22/2020

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