=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952124612
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NEUROLOGY & NEUROONCOLOGY CONSULTANT LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/01/2024
-----------------------------------------------------
Last Update Date | 11/01/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2240 SW 76TH LN
-----------------------------------------------------
City | OCALA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34476-6770
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 224-420-2453
-----------------------------------------------------
Fax | 352-323-1402
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2240 SW 76TH LN
-----------------------------------------------------
City | OCALA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34476-6770
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 224-420-2453
-----------------------------------------------------
Fax | 352-323-1402
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/MANAGER
-----------------------------------------------------
Name | AYMAN I OMAR
-----------------------------------------------------
Credential | MD, PHD
-----------------------------------------------------
Telephone | 224-420-2453
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084N0400X
-----------------------------------------------------
Taxonomy Name | Neurology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------