Healthcare Provider Details

I. General information

NPI: 1639207319
Provider Name (Legal Business Name): GARDEN CITY NEUROLOGY, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 RESERVOIR AVE
CRANSTON RI
02910-4417
US

IV. Provider business mailing address

900 RESERVOIR AVE
CRANSTON RI
02910-4417
US

V. Phone/Fax

Practice location:
  • Phone: 401-714-0222
  • Fax: 401-714-0220
Mailing address:
  • Phone: 401-714-0222
  • Fax: 401-714-0220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License NumberMD10970
License Number StateRI

VIII. Authorized Official

Name: DR. RICHARD LOUIS CERVONE
Title or Position: PRESIDENT
Credential: M.D.
Phone: 401-714-0222