=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578219507
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PRIME NEUROLOGY CENTER OF EXCELLENCE PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/28/2022
-----------------------------------------------------
Last Update Date | 06/07/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3345 BURNS RD STE 306
-----------------------------------------------------
City | PALM BEACH GARDENS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33410-4321
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-971-5261
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 324 S BREVARD AVE
-----------------------------------------------------
City | ARCADIA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34266-4309
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 863-558-1054
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | DR. MITESH PATEL
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 863-558-1054
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084N0400X
-----------------------------------------------------
Taxonomy Name | Neurology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------