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General NPI Number Information
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NPI Number | 1265996144
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Entity Type | Organization
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Legal Business Name | NEUROLOGY AND PAIN MEDICAL ASSOCIATES LLC
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Dates
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Enumeration Date | 01/25/2019
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Last Update Date | 06/09/2021
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Provider Practice Location Address
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Address Line | 130 PROFESSIONAL CT STE D
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City | LAFAYETTE
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State | IN
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Zip | 47905-5153
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Country | US
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Telephone | 765-446-8888
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Fax | 219-866-7001
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Provider Business Mailing Address
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Address Line | 123 S MCKINLEY AVE
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City | RENSSELAER
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State | IN
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Zip | 47978-2949
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Country | US
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Telephone | 219-866-7222
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Fax | 219-866-7001
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Authorized Official
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Title or Position | OWNER
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Name | JULIAN UNGAR-SARGON
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Credential | MD
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Telephone | 219-866-7222
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number |
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License Number State |
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