Healthcare Provider Details

I. General information

NPI: 1770364564
Provider Name (Legal Business Name): PHOENIX NEUROLOGICAL INSTITUTE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2023
Last Update Date: 10/09/2023
Certification Date: 10/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2226 W NORTHERN AVE STE C212
PHOENIX AZ
85021-4929
US

IV. Provider business mailing address

1343 N ALMA SCHOOL RD STE 160
CHANDLER AZ
85224-5901
US

V. Phone/Fax

Practice location:
  • Phone: 480-444-7472
  • Fax: 480-912-7910
Mailing address:
  • Phone: 480-444-7472
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: ANUPAM AHLAWAT
Title or Position: COO
Credential:
Phone: 480-444-7447