Healthcare Provider Details

I. General information

NPI: 1740460229
Provider Name (Legal Business Name): ALL NEUROLOGICAL SERVICES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2007
Last Update Date: 11/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9709 64TH RD REGO PARK
REGO PARK NY
11374-2254
US

IV. Provider business mailing address

1041 ARCADIAN WAY FORT LEE
FORT LEE NJ
07024-6349
US

V. Phone/Fax

Practice location:
  • Phone: 718-743-7090
  • Fax: 718-743-7581
Mailing address:
  • Phone: 718-376-3200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number196963
License Number StateNY

VIII. Authorized Official

Name: IGOR KHELEMSKY
Title or Position: PRESIDENT
Credential: MD
Phone: 718-376-3200