MEDICARE: ENCINO NEUROLOGICAL MEDICAL GROUP

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	174400000X	Specialist	G021066	CA

General Provider Information

NPI Number	:	1700884871
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ENCINO NEUROLOGICAL MEDICAL GROUP

Provider Business Mailing Address
First Line	:	16311 VENTURA BLVD
Second Line	:	SUITE 680
City	:	ENCINO
State	:	CA
Zip	:	91436-2124
Country	:	US
Telephone Number	:	818-990-8561
Fax Number	:	818-990-4432

Provider Business Practice Location Address
First Line	:	16311 VENTURA BLVD
Second Line	:	SUITE 680
City	:	ENCINO
State	:	CA
Zip	:	91436-2124
Country	:	US
Telephone Number	:	818-990-8561
Fax Number	:	818-990-4432

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	ROBERT FREUNDLICH
Credential	:	M.D.
Telephone Number	:	818-990-8561

Provider Enumeration Date	:	07/12/2005
Last Update Date	:	12/09/2008

Similar Medicare Providers

1700884905 — ARTHUR P. KOWELL M.D.
Practice Location Address:

16311 VENTURA BLVD , SUITE 680
ENCINO, CA
91436-2124

Practice Phone: 818-990-8561
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1881692093 — DR. ROBERT FREUNDLICH M.D.
Practice Location Address:

16311 VENTURA BLVD , SUITE 680
ENCINO, CA
91436-2124

Practice Phone: 818-990-8561
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1295727659 — DR. FRANKLIN D NIVER D.M.D.
Practice Location Address:

16311 VENTURA BLVD , SUITE 1110
ENCINO, CA
91436-2124

Practice Phone: 818-788-6600
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1386633303 — STEVEN ZLATT M.D.
Practice Location Address:

16311 VENTURA BLVD , #705/710
ENCINO, CA
91436-2124

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Practice Fax:

1982685996 — DR. MARK WELLISCH M.D.
Practice Location Address:

16311 VENTURA BLVD , SUITE 800
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1669453676 — DR. ELLIOT RYAN CARLISLE M.D.
Practice Location Address:

16311 VENTURA BLVD , SUITE 800
ENCINO, CA
91436-2124

Practice Phone: 818-788-7343
Practice Fax: 818-788-9453

Directions to “ENCINO NEUROLOGICAL MEDICAL GROUP ” Practice Location

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