Provider Demographics
NPI:1265996144
Name:NEUROLOGY AND PAIN MEDICAL ASSOCIATES LLC
Entity type:Organization
Organization Name:NEUROLOGY AND PAIN MEDICAL ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JULIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:UNGAR-SARGON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:219-866-7222
Mailing Address - Street 1:123 S MCKINLEY AVE
Mailing Address - Street 2:
Mailing Address - City:RENSSELAER
Mailing Address - State:IN
Mailing Address - Zip Code:47978-2949
Mailing Address - Country:US
Mailing Address - Phone:219-866-7222
Mailing Address - Fax:219-866-7001
Practice Address - Street 1:130 PROFESSIONAL CT STE D
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-5153
Practice Address - Country:US
Practice Address - Phone:765-446-8888
Practice Address - Fax:219-866-7001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-25
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN01040129AOtherMEDICAL LICESNE