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General NPI Number Information
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NPI Number | 1780915959
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Entity Type | Organization
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Legal Business Name | PEDIATRIC NEUROLOGY OF NORTH CAROLINA PA
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Dates
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Enumeration Date | 01/27/2010
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Last Update Date | 01/27/2010
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Provider Practice Location Address
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Address Line | 206 TOWNE VILLAGE DR
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City | CARY
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State | NC
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Zip | 27513-8910
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Country | US
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Telephone | 919-380-3092
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Fax | 206-339-7662
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Provider Business Mailing Address
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Address Line | 206 TOWNE VILLAGE DR
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City | CARY
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State | NC
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Zip | 27513-8910
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Country | US
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Telephone | 919-380-3092
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Fax | 206-339-7662
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Authorized Official
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Title or Position | OWNER
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Name | DAVID JAY JAFFE
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Credential | MD
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Telephone | 919-380-3092
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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 | 87482
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License Number State | NC
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