Healthcare Provider Details

I. General information

NPI: 1316940851
Provider Name (Legal Business Name): NEUROPSYCHIATRIC ASSOCIATES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2005
Last Update Date: 02/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2410 N GLENDALE DR STE A
FORT WAYNE IN
46804-8909
US

IV. Provider business mailing address

2410 N GLENDALE DR STE A
FORT WAYNE IN
46804-8909
US

V. Phone/Fax

Practice location:
  • Phone: 260-432-5181
  • Fax: 260-432-5692
Mailing address:
  • Phone: 260-432-5181
  • Fax: 260-432-5692

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number50003238A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State

VIII. Authorized Official

Name: MR. NEAL K BISHT
Title or Position: CAO
Credential: MBA
Phone: 260-432-5181