Healthcare Provider Details

I. General information

NPI: 1881644250
Provider Name (Legal Business Name): ALPHA NEUROLOGY,PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 04/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27 NEW DORP LN
STATEN ISLAND NY
10306-2322
US

IV. Provider business mailing address

27 NEW DORP LN
STATEN ISLAND NY
10306-2322
US

V. Phone/Fax

Practice location:
  • Phone: 718-667-3597
  • Fax: 718-667-3590
Mailing address:
  • Phone: 718-667-3597
  • Fax: 718-667-3590

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number167203
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number196628
License Number StateNY

VIII. Authorized Official

Name: DR. ALLAN B PEREL
Title or Position: DIRECTOR
Credential: M.D.
Phone: 718-667-3597