Provider Demographics
NPI:1043375611
Name:NEUROLOGICAL DISORDERS CLINIC PA
Entity type:Organization
Organization Name:NEUROLOGICAL DISORDERS CLINIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:FERNANO
Authorized Official - Middle Name:
Authorized Official - Last Name:NORONA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-394-0005
Mailing Address - Street 1:880 NW 13TH ST
Mailing Address - Street 2:SUITE 3-B
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33486-2342
Mailing Address - Country:US
Mailing Address - Phone:561-394-0005
Mailing Address - Fax:561-393-0048
Practice Address - Street 1:880 NW 13TH ST
Practice Address - Street 2:SUITE 3-B
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486-2342
Practice Address - Country:US
Practice Address - Phone:561-394-0005
Practice Address - Fax:561-393-0048
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-26
Last Update Date:2010-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL74877174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2338601OtherAETNA HMO
NEWM988OtherEMPIRE BC BS
FL032627OtherNHP
FL2338601OtherAETNA
DC49479ZOtherMEDICARE INDIVIDUAL
FL1026677OtherCARE PLU
FL49479OtherBLUE SHIELD FL PROVIDER
FL5890751OtherAETNA NON HMO
FL74877OtherFL LICENSE NUMBER
DC49479ZOtherMEDICARE INDIVIDUAL
NEWM988OtherEMPIRE BC BS