=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366734014
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | INTEGRATIVE NEUROLOGY, P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/12/2011
-----------------------------------------------------
Last Update Date | 10/05/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1174 ROUTE 112
-----------------------------------------------------
City | PORT JEFFERSON STATION
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11776-8003
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-509-1730
-----------------------------------------------------
Fax | 631-509-1728
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1174 ROUTE 112
-----------------------------------------------------
City | PORT JEFFERSON STATION
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11776-8033
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-509-1730
-----------------------------------------------------
Fax | 631-509-1728
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. FRANK WOHLSEIN TELANG
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 631-509-1730
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 222694
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------