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General NPI Number Information
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NPI Number | 1497152417
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Entity Type | Organization
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Legal Business Name | NEUROLOGY, MOVEMENT DISORDERS AND DYSTONIA, LLC
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Dates
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Enumeration Date | 11/20/2014
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Last Update Date | 10/06/2015
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Provider Practice Location Address
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Address Line | 14 PECK ST
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City | NORTH HAVEN
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State | CT
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Zip | 06473-2307
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Country | US
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Telephone | 203-773-3245
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Fax | 203-777-3588
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Provider Business Mailing Address
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Address Line | 14 PECK ST
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City | NORTH HAVEN
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State | CT
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Zip | 06473-2307
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Country | US
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Telephone | 203-773-3245
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Fax | 203-777-3588
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | DR. SANJAY P. RATHI
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Credential | M.D.
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Telephone | 203-773-3245
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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 | 037827
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License Number State | CT
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