Healthcare Provider Details

I. General information

NPI: 1275891871
Provider Name (Legal Business Name): FAMILY NEUROLOGY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2012
Last Update Date: 05/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2604 169TH ST
FLUSHING NY
11358-1131
US

IV. Provider business mailing address

229 E 85TH ST UNIT 675
NEW YORK NY
10028-9600
US

V. Phone/Fax

Practice location:
  • Phone: 718-570-6086
  • Fax:
Mailing address:
  • Phone: 718-570-6086
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number208225
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number208225
License Number StateNY

VIII. Authorized Official

Name: DR. ROCCO FRANCO
Title or Position: OWNER
Credential: MD
Phone: 718-570-6086