=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568619732
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NEO SERVICES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/19/2008
-----------------------------------------------------
Last Update Date | 05/21/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3060 WILLIAMS DRIVE SUITE 520
-----------------------------------------------------
City | FAIRFAX
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22031-4648
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-776-3547
-----------------------------------------------------
Fax | 703-289-1414
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3060 WILLIAMS DRIVE SUITE 520
-----------------------------------------------------
City | FAIRFAX
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22031-4648
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-226-2285
-----------------------------------------------------
Fax | 703-289-1414
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EVP, COO
-----------------------------------------------------
Name | MR. GREGORY EDWARD BENGSTON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 703-289-1422
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------