Basic Information
| Provider Information | |||||||||
| NPI: | 1396170981 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CLINICAL NEUROSCIENCE SERVICES MED/SURG PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4050 HARLEM RD | ||||||||
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| City: | AMHERST | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142264711 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7168031507 | ||||||||
| FaxNumber: | 7168031508 | ||||||||
| Practice Location | |||||||||
| Address1: | 4050 HARLEM RD | ||||||||
| Address2: | |||||||||
| City: | AMHERST | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142264711 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7168031507 | ||||||||
| FaxNumber: | 7168031508 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/13/2013 | ||||||||
| LastUpdateDate: | 09/13/2013 | ||||||||
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| AuthorizedOfficialLastName: | GUTERMAN | ||||||||
| AuthorizedOfficialFirstName: | LEE | ||||||||
| AuthorizedOfficialMiddleName: | RAND | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7168031507 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207T00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Neurological Surgery |
No ID Information.