Provider Demographics
NPI:1861159873
Name:NEUROLOGY OF CALIFORNIA PC
Entity type:Organization
Organization Name:NEUROLOGY OF CALIFORNIA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAREY
Authorized Official - Middle Name:
Authorized Official - Last Name:POWELLL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-882-3456
Mailing Address - Street 1:700 US HIGHWAY 46 STE 420
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07004-1532
Mailing Address - Country:US
Mailing Address - Phone:973-882-3456
Mailing Address - Fax:973-882-3450
Practice Address - Street 1:4867 W SUNSET BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-5969
Practice Address - Country:US
Practice Address - Phone:973-882-3456
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-24
Last Update Date:2021-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0591467Medicaid
NY05952754Medicaid