Healthcare Provider Details

I. General information

NPI: 1326049388
Provider Name (Legal Business Name): PA INSTITUTE OF NEUROLOGICAL DISORDER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2005
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

512 MARKET ST
SUNBURY PA
17801-2338
US

IV. Provider business mailing address

512 MARKET ST
SUNBURY PA
17801-2338
US

V. Phone/Fax

Practice location:
  • Phone: 570-286-9878
  • Fax: 570-286-9848
Mailing address:
  • Phone: 570-286-9878
  • Fax: 570-286-9848

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberMD039921Y
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License NumberMD039921Y
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code2084P2900X
TaxonomyPain Medicine (Psychiatry & Neurology) Physician
License NumberMD039921Y
License Number StatePA

VIII. Authorized Official

Name: MAHMOOD NASIR
Title or Position: PRESIDENT
Credential: MD
Phone: 570-286-9878