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General NPI Number Information
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NPI Number | 1487876660
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Entity Type | Organization
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Legal Business Name | NEUROCARE, INC.
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Dates
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Enumeration Date | 05/03/2007
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Last Update Date | 11/15/2010
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Provider Practice Location Address
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Address Line | 1510 COLUMBINE AVE
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City | BOULDER
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State | CO
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Zip | 80302-7943
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Country | US
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Telephone | 303-586-1556
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Fax | 215-839-8932
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Provider Business Mailing Address
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Address Line | 1510 COLUMBINE AVE
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City | BOULDER
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State | CO
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Zip | 80302-7943
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Country | US
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Telephone | 303-586-1556
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Fax | 215-839-8932
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ROBERT IRA WINER
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Credential | MD
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Telephone | 303-586-1556
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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 | MD023070E
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License Number State | PA
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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 | MD023070E
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License Number State | PA
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