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General NPI Number Information
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NPI Number | 1164727277
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Entity Type | Organization
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Legal Business Name | NEUROLOGY CENTER OF PHILADELPHIA INC.
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Dates
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Enumeration Date | 01/20/2011
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Last Update Date | 02/14/2011
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Provider Practice Location Address
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Address Line | 9922 ROOSEVELT BLVD
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City | PHILADELPHIA
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State | PA
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Zip | 19115-1705
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Country | US
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Telephone | 215-870-2551
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Fax |
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Provider Business Mailing Address
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Address Line | 9922 ROOSEVELT BLVD
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City | PHILADELPHIA
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State | PA
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Zip | 19115-1705
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Country | US
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Telephone | 215-870-2551
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MIKHAIL SHAMAYEV
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Credential | MD
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Telephone | 215-870-2551
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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 | MD432308
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License Number State | PA
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