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General NPI Number Information
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NPI Number | 1275791972
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Entity Type | Organization
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Legal Business Name | NEUROPSYCHOLOGIC ASSOCIATES, PLLC
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Dates
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Enumeration Date | 05/29/2008
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Last Update Date | 05/29/2008
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Provider Practice Location Address
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Address Line | 500 W MAIN ST SUITE 208
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City | BABYLON
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State | NY
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Zip | 11702-3027
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Country | US
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Telephone | 631-482-1200
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Fax |
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Provider Business Mailing Address
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Address Line | 500 W MAIN ST SUITE 208
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City | BABYLON
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State | NY
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Zip | 11702-3027
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Country | US
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Telephone | 631-482-1200
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Fax |
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | DR. ROBERT LOUIS VILLANELLA
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Credential | PH.D.
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Telephone | 631-482-1200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | 014582
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License Number State | NY
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