Provider Demographics
NPI:1366734014
Name:INTEGRATIVE NEUROLOGY, P.C.
Entity type:Organization
Organization Name:INTEGRATIVE NEUROLOGY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:WOHLSEIN
Authorized Official - Last Name:TELANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-509-1730
Mailing Address - Street 1:1174 ROUTE 112
Mailing Address - Street 2:
Mailing Address - City:PORT JEFFERSON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11776-8033
Mailing Address - Country:US
Mailing Address - Phone:631-509-1730
Mailing Address - Fax:631-509-1728
Practice Address - Street 1:1174 ROUTE 112
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON STATION
Practice Address - State:NY
Practice Address - Zip Code:11776-8003
Practice Address - Country:US
Practice Address - Phone:631-509-1730
Practice Address - Fax:631-509-1728
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-12
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY222694174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty