=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154746378
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NEUROLOGY PAIN CARE, P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/25/2014
-----------------------------------------------------
Last Update Date | 02/25/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6818 3RD AVE
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11220-5803
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-932-2004
-----------------------------------------------------
Fax | 718-932-2005
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6818 3RD AVE
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11220-5803
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-932-2004
-----------------------------------------------------
Fax | 718-932-2005
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEDICAL DIRECTOR/OWNER
-----------------------------------------------------
Name | DR. HAZEM ALI
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 718-932-2004
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 173000000X
-----------------------------------------------------
Taxonomy Name | Legal Medicine
-----------------------------------------------------
License Number | 243188
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------