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General NPI Number Information
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NPI Number | 1053629477
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Entity Type | Organization
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Legal Business Name | NY NEUROLOGICAL CONSULTANT, PC
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Dates
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Enumeration Date | 09/20/2010
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Last Update Date | 07/03/2018
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Provider Practice Location Address
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Address Line | 350 FORT WASHINGTON AVE
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City | NEW YORK
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State | NY
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Zip | 10033
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Country | US
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Telephone | 212-927-3327
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Fax | 212-927-3307
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Provider Business Mailing Address
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Address Line | 350 FORT WASHINGTON AVE
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City | NEW YORK
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State | NY
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Zip | 10033-6846
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Country | US
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Telephone | 212-927-3327
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Fax | 212-927-3307
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | CASILDA BALMACEDA
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Credential | MD
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Telephone | 212-927-3327
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 186529
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License Number State | NY
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