Provider Demographics
NPI:1174115612
Name:NEUROLOGY & NEURODIAGNOSTIC CLINIC OF HOUSTON, PLLC
Entity type:Organization
Organization Name:NEUROLOGY & NEURODIAGNOSTIC CLINIC OF HOUSTON, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALI
Authorized Official - Middle Name:
Authorized Official - Last Name:MOUSSAOUI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:832-469-0712
Mailing Address - Street 1:PO BOX 58805
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-8805
Mailing Address - Country:US
Mailing Address - Phone:281-942-8001
Mailing Address - Fax:832-743-3978
Practice Address - Street 1:18300 HOUSTON METHODIST DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-6302
Practice Address - Country:US
Practice Address - Phone:281-333-5503
Practice Address - Fax:832-743-3978
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-05
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty