Healthcare Provider Details

I. General information

NPI: 1033305743
Provider Name (Legal Business Name): LEXINGTON NEUROSCIENCES CENTER PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2007
Last Update Date: 08/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2708 OLD ROSEBUD ROAD
LEXINGTON KY
40509
US

IV. Provider business mailing address

2708 OLD ROSEBUD RD
LEXINGTON KY
40509-8559
US

V. Phone/Fax

Practice location:
  • Phone: 859-255-1009
  • Fax: 859-255-0740
Mailing address:
  • Phone: 859-255-1009
  • Fax: 859-255-0740

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License Number
License Number State

VIII. Authorized Official

Name: JALIL SHOJAEI
Title or Position: MD
Credential:
Phone: 859-255-1009