Healthcare Provider Details

I. General information

NPI: 1528414422
Provider Name (Legal Business Name): NEUFRONTIERS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2016
Last Update Date: 05/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 BLACKSTONE BLVD CENTER HOUSE ROOM 246
PROVIDENCE RI
02906-4800
US

IV. Provider business mailing address

22 LEICESTER WAY
PAWTUCKET RI
02860-5610
US

V. Phone/Fax

Practice location:
  • Phone: 401-455-6506
  • Fax: 401-455-6309
Mailing address:
  • Phone: 917-669-2645
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084B0040X
TaxonomyBehavioral Neurology & Neuropsychiatry Physician
License NumberMD14779
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberMD14779
License Number StateRI
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD14779
License Number StateRI

VIII. Authorized Official

Name: BENJAMIN ALEXANDER MARGOLIS
Title or Position: OWNER/PHYSICIAN
Credential: M.D.
Phone: 917-669-2645