Healthcare Provider Details

I. General information

NPI: 1497879373
Provider Name (Legal Business Name): NEUROLOGICAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4265 5TH PL
VERO BEACH FL
32968-1961
US

IV. Provider business mailing address

PO BOX 6394
VERO BEACH FL
32961-6394
US

V. Phone/Fax

Practice location:
  • Phone: 772-770-9339
  • Fax:
Mailing address:
  • Phone: 772-770-9339
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P2900X
TaxonomyPain Medicine (Psychiatry & Neurology) Physician
License NumberME0021496
License Number StateFL

VIII. Authorized Official

Name: HOOSHANG HOOSHMAND
Title or Position: ADMINISTRATOR
Credential:
Phone: 772-770-9339