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General NPI Number Information
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NPI Number | 1881955086
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Entity Type | Organization
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Legal Business Name | PARADIGM NEUROLOGICAL SERVICES, PC
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Dates
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Enumeration Date | 06/04/2012
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Last Update Date | 06/04/2012
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Provider Practice Location Address
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Address Line | 21814 NORTHERN BLVD SUITE 101
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City | BAYSIDE
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State | NY
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Zip | 11361-3581
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Country | US
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Telephone | 718-229-4868
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Fax |
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Provider Business Mailing Address
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Address Line | 21814 NORTHERN BLVD SUITE 101
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City | BAYSIDE
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State | NY
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Zip | 11361-3581
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Country | US
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Telephone | 718-229-4868
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CHARLES H BAGLEY
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Credential | MD
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Telephone | 718-229-4868
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P2900X
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Taxonomy Name | Pain Medicine (Psychiatry & Neurology) Physician
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License Number | 132024
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License Number State | NY
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