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EAST COAST NEURO LLC NPI 1124424643


NPI Information

NPI: 1124424643
Provider Name: EAST COAST NEURO LLC

Doing Business As: EAST COAST INJURY CLINIC

Classification: Psychiatry & Neurology - 2084N0400X
Entity Type: Organization

Specialization: Neurology

CLIA Number: 10D2241304

Address:
10550 DEERWOOD PARK BLVD STE 609A
JACKSONVILLE, FL
ZIP 32256
Phone: (904) 513-3954
Get Directions

EAST COAST NEURO LLC is a neurology psychiatry neurology in Jacksonville, FL. The provider is a Neurologist specializes in the diagnosis and treatment of diseases or impaired function of the brain, spinal cord, peripheral nerves, muscles, autonomic nervous system, and blood vessels that relate to these structures. EAST COAST NEURO LLC NPI is 1124424643. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As East Coast Injury Clinic.

The provider's business location address is:

10550 DEERWOOD PARK BLVD STE 609A
JACKSONVILLE, FL
ZIP 32256-811
Phone: (904) 513-3954
Fax: (904) 212-0223

The provider's authorized official is Vanessa Jaclyn Wilczak .
The authorized official title is Authorized Official and has the following contact phone number (904) 513-3954.

The CLIA number assigned to this NPI record is 10D2241304 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 11/11/2014 and was last updated on 1/5/2023.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1111NN0400XChiropractorNeurologyNo
2208100000XPhysical Medicine & RehabilitationNo
32084N0400XPsychiatry & NeurologyNeurologyYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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