Healthcare Provider Details

I. General information

NPI: 1356463640
Provider Name (Legal Business Name): NEUROPSYCHIATRY CONSULTANTS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 11/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 ALLENTOWN RD
LIMA OH
45805-1873
US

IV. Provider business mailing address

1800 ALLENTOWN RD
LIMA OH
45805-1873
US

V. Phone/Fax

Practice location:
  • Phone: 419-229-0415
  • Fax: 419-229-0419
Mailing address:
  • Phone: 419-229-0415
  • Fax: 419-229-0419

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0015X
TaxonomyPsychosomatic Medicine Physician
License Number72394
License Number StateOH

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierDN5964
Identifier TypeOTHER
Identifier StateOH
Identifier IssuerMEDICARE RAILROAD
# 2
Identifier000000162845
Identifier TypeOTHER
Identifier StateOH
Identifier IssuerANTHEM BCBS

VIII. Authorized Official

Name: DR. RICHARD ADAM NOCKOWITZ
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 419-229-0415