=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497857627
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NEUROLOGICAL ASSOC OF NENY PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/01/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1401 UNION ST
-----------------------------------------------------
City | SCHENECTADY
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12308-3009
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-399-3969
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1737 UNION ST 461
-----------------------------------------------------
City | SCHENECTADY
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12309-6242
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-399-3969
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. RICHARD B BROOKS
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 518-468-8618
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084N0400X
-----------------------------------------------------
Taxonomy Name | Neurology Physician
-----------------------------------------------------
License Number | 133021-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------