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Organization
YOUNGSTOWN NEUROLOGIC ASSOCIATES
Active
Organization
YOUNGSTOWN NEUROLOGIC ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRIAN P BROCKER M.D. (PRESIDENT)
(330) 747-9215
Entity
Organization
Contact information
Practice address
1616 COVINGTON ST, YOUNGSTOWN, OH 44510-1244
(330) 747-9215
(330) 747-9248
Mailing address
1616 COVINGTON ST, YOUNGSTOWN, OH 44510-1244
(330) 747-9215
(330) 747-9248
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT-09049
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000104951
UNISON #
OH
01
—
0034184
CHAMPUS #
OH
05
—
0120489
—
OH
01
—
1526878
PA MEDICAID #
OH
Enumeration date
03/07/2007
Last updated
08/22/2020
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