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General NPI Number Information
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NPI Number | 1407268808
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Entity Type | Organization
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Legal Business Name | ADVANTAGE NEUROLOGY GROUP LLC
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Dates
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Enumeration Date | 05/20/2014
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Last Update Date | 05/20/2014
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Provider Practice Location Address
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Address Line | 6810 N STATE ROAD 7
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City | COCONUT CREEK
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State | FL
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Zip | 33073-4304
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Country | US
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Telephone | 888-992-2259
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Fax | 888-613-0761
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Provider Business Mailing Address
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Address Line | 6810 N STATE ROAD 7
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City | COCONUT CREEK
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State | FL
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Zip | 33073-4304
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Country | US
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Telephone | 888-992-2259
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Fax | 888-613-0761
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. SUSAN WHITNEY
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Credential |
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Telephone | 888-992-2259
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | ME31479
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License Number State | FL
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