Provider Demographics
NPI:1871546689
Name:NEUROLOGY INSTITUTE OF MELBOURNE PA
Entity type:Organization
Organization Name:NEUROLOGY INSTITUTE OF MELBOURNE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:MAHLON
Authorized Official - Last Name:UNGER
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:321-725-6999
Mailing Address - Street 1:PO BOX 459
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32902-0459
Mailing Address - Country:US
Mailing Address - Phone:321-725-6999
Mailing Address - Fax:321-725-6981
Practice Address - Street 1:116 SILVER PALM AVE
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-3172
Practice Address - Country:US
Practice Address - Phone:321-725-6999
Practice Address - Fax:321-725-6981
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME801682084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL259417000Medicaid
FL35458OtherBLUE CROSS
FLH13684Medicare UPIN
FLK9396AMedicare PIN