Provider Demographics
NPI:1780891333
Name:CENTERS FOR NEUROLOGICAL SURGERY
Entity type:Organization
Organization Name:CENTERS FOR NEUROLOGICAL SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:S
Authorized Official - Last Name:SCHNITZER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-525-7177
Mailing Address - Street 1:PO BOX 5907
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90622-9998
Mailing Address - Country:US
Mailing Address - Phone:877-222-0969
Mailing Address - Fax:866-440-4397
Practice Address - Street 1:1400 N HARBOR BLVD
Practice Address - Street 2:STE 440
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-4192
Practice Address - Country:US
Practice Address - Phone:714-585-7177
Practice Address - Fax:714-525-6769
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA52917207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW13693AMedicare ID - Type UnspecifiedPRACTICE ID