Healthcare Provider Details

I. General information

NPI: 1740595222
Provider Name (Legal Business Name): NEUROLOGY AND PAIN MANAGEMENT CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2010
Last Update Date: 08/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 BENNETT AVE SUITE 1B
MILFORD PA
18337-9759
US

IV. Provider business mailing address

104 BENNETT AVE SUITE 1B
MILFORD PA
18337-9759
US

V. Phone/Fax

Practice location:
  • Phone: 570-296-8494
  • Fax: 570-296-8493
Mailing address:
  • Phone: 570-296-8494
  • Fax: 570-296-8493

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberMD428963
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code2084P2900X
TaxonomyPain Medicine (Psychiatry & Neurology) Physician
License NumberMD428963
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code2084D0003X
TaxonomyDiagnostic Neuroimaging (Psychiatry & Neurology) Physician
License NumberMD428963
License Number StatePA

VIII. Authorized Official

Name: DR. FUHAI LI
Title or Position: PRESIDENT
Credential: M.D.
Phone: 570-296-8494