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General NPI Number Information
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NPI Number | 1295937373
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Entity Type | Organization
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Legal Business Name | NEUROLOGIC ASSOCIATES OF CENTRAL BREVARD INC
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Dates
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Enumeration Date | 06/01/2007
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Last Update Date | 01/10/2012
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Provider Practice Location Address
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Address Line | 1395 N COURTENAY PKWY SUITE #106
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City | MERRITT ISLAND
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State | FL
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Zip | 32953-4400
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Country | US
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Telephone | 321-452-1224
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Fax | 321-453-7784
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Provider Business Mailing Address
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Address Line | 1395 N COURTENAY PKWY SUITE #106
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City | MERRITT ISLAND
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State | FL
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Zip | 32953-4400
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Country | US
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Telephone | 321-452-1224
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Fax | 321-453-7784
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | PATRICIA VALLUZZI
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Credential |
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Telephone | 321-452-1224
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry 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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