Provider Demographics
NPI:1336943778
Name:ORCHARD PARK CHILD NEUROLOGY, PLLC
Entity type:Organization
Organization Name:ORCHARD PARK CHILD NEUROLOGY, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GOSSETT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-859-7697
Mailing Address - Street 1:7920 BELT LINE RD STE 685
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75254-8145
Mailing Address - Country:US
Mailing Address - Phone:214-544-6474
Mailing Address - Fax:214-544-6498
Practice Address - Street 1:7920 BELT LINE RD STE 685
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75254-8145
Practice Address - Country:US
Practice Address - Phone:713-859-7697
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-03
Last Update Date:2025-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center