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General NPI Number Information
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NPI Number | 1639207319
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Entity Type | Organization
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Legal Business Name | GARDEN CITY NEUROLOGY, LTD
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Dates
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Enumeration Date | 03/02/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 900 RESERVOIR AVE
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City | CRANSTON
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State | RI
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Zip | 02910-4417
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Country | US
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Telephone | 401-714-0222
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Fax | 401-714-0220
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Provider Business Mailing Address
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Address Line | 900 RESERVOIR AVE
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City | CRANSTON
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State | RI
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Zip | 02910-4417
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Country | US
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Telephone | 401-714-0222
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Fax | 401-714-0220
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RICHARD LOUIS CERVONE
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Credential | M.D.
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Telephone | 401-714-0222
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0600X
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Taxonomy Name | Clinical Neurophysiology Physician
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License Number | MD10970
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License Number State | RI
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