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General NPI Number Information
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NPI Number | 1194704544
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Entity Type | Organization
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Legal Business Name | BREVARD NEUROLOGY ASSOCIATES PA
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Dates
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Enumeration Date | 01/13/2006
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Last Update Date | 04/12/2013
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Provider Practice Location Address
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Address Line | 1910 ROCKLEDGE BLVD UNIT 101
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City | ROCKLEDGE
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State | FL
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Zip | 32955
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Country | US
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Telephone | 321-636-8366
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Fax | 321-636-3985
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Provider Business Mailing Address
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Address Line | 1910 ROCKLEDGE BLVD UNIT 101
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City | ROCKLEDGE
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State | FL
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Zip | 32955
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Country | US
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Telephone | 321-636-8366
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Fax | 321-636-3985
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Authorized Official
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Title or Position | CORPORATE OFFICE
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Name | MR. WASIM NIAZI
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Credential | MD
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Telephone | 321-636-8366
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number | ME58732
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License Number State | FL
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