Healthcare Provider Details

I. General information

NPI: 1568758621
Provider Name (Legal Business Name): CENTRAL QUEENS NEUROLOGY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2011
Last Update Date: 06/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9801 67TH AVE APT. 6C
REGO PARK NY
11374-4967
US

IV. Provider business mailing address

9801 67TH AVE APT. 6C
REGO PARK NY
11374-4967
US

V. Phone/Fax

Practice location:
  • Phone: 917-952-2464
  • Fax:
Mailing address:
  • Phone: 917-952-2464
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number194262
License Number StateNY

VIII. Authorized Official

Name: GARY SCLAR
Title or Position: OWNER
Credential: MD
Phone: 917-952-8464