MEDICARE: FOUR NEUROSCIENCE INSTITUTE AND SPINE CENTER LLC

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	207T00000X	Neurological Surgery Physician

General Provider Information

NPI Number	:	1568397453
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOUR NEUROSCIENCE INSTITUTE AND SPINE CENTER LLC

Provider Business Mailing Address
First Line	:	545 N RIVER ST STE 130
Second Line	:
City	:	WILKES BARRE
State	:	PA
Zip	:	18702-2600
Country	:	US
Telephone Number	:	617-470-0887
Fax Number	:

Provider Business Practice Location Address
First Line	:	545 N RIVER ST STE 130
Second Line	:
City	:	WILKES BARRE
State	:	PA
Zip	:	18702-2600
Country	:	US
Telephone Number	:	617-470-0887
Fax Number	:

Authorized Official
Title or Position	:	CEO/OWNER
Name	:	DR. DR VICTOR CHUKWUEMEKA UDEKWU
Credential	:	MD
Telephone Number	:	617-470-0887

Provider Enumeration Date	:	06/15/2026
Last Update Date	:	06/15/2026

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