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General NPI Number Information
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NPI Number | 1144879206
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Entity Type | Organization
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Legal Business Name | NEUROLOGICAL CLINIC, SC
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Dates
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Enumeration Date | 09/10/2019
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Last Update Date | 09/10/2019
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Provider Practice Location Address
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Address Line | 7700 LITTLE RIVER TPKE STE 605
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City | ANNANDALE
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State | VA
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Zip | 22003-2400
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Country | US
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Telephone | 571-620-7159
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Fax | 571-620-7571
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Provider Business Mailing Address
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Address Line | 5525 GREEN BAY RD
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City | KENOSHA
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State | WI
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Zip | 53144-3737
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Country | US
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Telephone | 262-657-2060
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Fax | 262-657-2069
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BYUNG H. PARK
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Credential | MD
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Telephone | 262-880-5525
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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