Provider Demographics
NPI:1669708665
Name:MID ATLANTIC NEUROLOGY & SLEEP MEDICINE, P.A.
Entity type:Organization
Organization Name:MID ATLANTIC NEUROLOGY & SLEEP MEDICINE, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KHALED
Authorized Official - Middle Name:F
Authorized Official - Last Name:JREISAT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:252-474-3863
Mailing Address - Street 1:PO BOX 12067
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28561-2067
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:227 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-6333
Practice Address - Country:US
Practice Address - Phone:910-353-3624
Practice Address - Fax:910-353-0050
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MID ATLANTIC NEUROLOGY & SLEEP MEDICINE, P.A.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-10-26
Last Update Date:2009-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Multi-Specialty