MEDICARE: NEUROLOGY GROUP, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084N0400X	Neurology Physician	196730	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1336185313	OTHER	NY	NPI 1336185313

General Provider Information

NPI Number	:	1336185313
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEUROLOGY GROUP, PLLC

Provider Business Mailing Address
First Line	:	7620 BAY PKWY STE 1A
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11214-1516
Country	:	US
Telephone Number	:	718-232-1022
Fax Number	:	718-232-1014

Provider Business Practice Location Address
First Line	:	7620 BAY PKWY STE 1A
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11214-1516
Country	:	US
Telephone Number	:	718-232-1022
Fax Number	:	718-232-1014

Authorized Official
Title or Position	:	OWNER
Name	:	YAN LUPYAN
Credential	:	MD
Telephone Number	:	718-232-1022

Provider Enumeration Date	:	06/20/2006
Last Update Date	:	10/18/2011

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