Provider Demographics
NPI:1871989392
Name:PHOENIX NEUROLOGICAL INSTITUTE INC
Entity type:Organization
Organization Name:PHOENIX NEUROLOGICAL INSTITUTE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MS
Authorized Official - First Name:ANUPAM
Authorized Official - Middle Name:
Authorized Official - Last Name:AHLAWAT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-294-4494
Mailing Address - Street 1:1343 N ALMA SCHOOL RD STE 160
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-5901
Mailing Address - Country:US
Mailing Address - Phone:480-963-1853
Mailing Address - Fax:
Practice Address - Street 1:1343 N ALMA SCHOOL RD STE 135
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-5941
Practice Address - Country:US
Practice Address - Phone:480-963-1853
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-10
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Multi-Specialty