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General NPI Number Information
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NPI Number | 1881127827
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Entity Type | Organization
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Legal Business Name | NEURON STREET LLC
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Dates
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Enumeration Date | 04/06/2017
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Last Update Date | 04/06/2017
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Provider Practice Location Address
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Address Line | 829 57TH ST SUITE # 5
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City | BROOKLYN
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State | NY
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Zip | 11220-3677
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Country | US
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Telephone | 718-686-1108
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Fax |
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Provider Business Mailing Address
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Address Line | 829 57TH ST SUITE # 5
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City | BROOKLYN
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State | NY
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Zip | 11220-3677
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Country | US
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Telephone | 718-686-1108
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | YONGMING MAO
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Credential |
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Telephone | 718-686-1108
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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