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General NPI Number Information
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NPI Number | 1952949380
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Entity Type | Organization
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Legal Business Name | NEUROGLIA PLLC
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Dates
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Enumeration Date | 12/16/2019
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Last Update Date | 12/16/2019
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Provider Practice Location Address
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Address Line | 1525 S HIGLEY RD STE 104
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City | GILBERT
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State | AZ
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Zip | 85296-5045
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Country | US
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Telephone | 847-913-4154
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Fax | 480-535-5858
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Provider Business Mailing Address
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Address Line | 1525 S HIGLEY RD STE 104
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City | GILBERT
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State | AZ
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Zip | 85296-5045
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Country | US
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Telephone | 847-913-4154
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Fax | 480-535-5858
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Authorized Official
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Title or Position | OWNER
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Name | DR. SURABHI YESHWANT PATWARDHAN
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Credential | PH.D.
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Telephone | 847-913-4154
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number |
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License Number State |
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