Healthcare Provider Details

I. General information

NPI: 1265996144
Provider Name (Legal Business Name): NEUROLOGY AND PAIN MEDICAL ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2019
Last Update Date: 06/09/2021
Certification Date: 06/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 PROFESSIONAL CT STE D
LAFAYETTE IN
47905-5153
US

IV. Provider business mailing address

123 S MCKINLEY AVE
RENSSELAER IN
47978-2949
US

V. Phone/Fax

Practice location:
  • Phone: 765-446-8888
  • Fax: 219-866-7001
Mailing address:
  • Phone: 219-866-7222
  • Fax: 219-866-7001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JULIAN UNGAR-SARGON
Title or Position: OWNER
Credential: MD
Phone: 219-866-7222