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General NPI Number Information
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NPI Number | 1790008811
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Entity Type | Organization
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Legal Business Name | NEUROLOGY & SPINE DISORDERS LLC
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Dates
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Enumeration Date | 03/03/2010
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Last Update Date | 09/08/2010
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Provider Practice Location Address
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Address Line | 5111 S RIDGEWOOD AVE SUITE 102
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City | PORT ORANGE
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State | FL
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Zip | 32127-5169
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Country | US
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Telephone | 386-763-4484
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Fax | 386-763-1288
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Provider Business Mailing Address
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Address Line | 1673 MASON AVE SUITE 107
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City | DAYTONA BEACH
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State | FL
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Zip | 32117-5515
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Country | US
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Telephone | 386-274-7118
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Fax | 386-274-6173
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Authorized Official
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Title or Position | CEO
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Name | MR. AL FALCO
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Credential |
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Telephone | 386-274-7118
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | ME46005
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License Number State | FL
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