Organization
BREVARD NEUROLOGY ASSOCIATES PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WASIM NIAZI MD (CORPORATE OFFICE)
(321) 636-8366
Entity
Organization
Contact information
Practice address
1910 ROCKLEDGE BLVD, UNIT 101, ROCKLEDGE, FL 32955
(321) 636-8366
(321) 636-3985
Mailing address
1910 ROCKLEDGE BLVD, UNIT 101, ROCKLEDGE, FL 32955
(321) 636-8366
(321) 636-3985
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
ME58732
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0500148
UNITED
FL
01
—
130016629
MEDICARE RR
FL
01
—
26705
26705
FL
05
—
377423600
—
FL
01
—
45249
BC BS GRP
FL
01
—
4657556
AETNA
FL
01
—
5395693
AETNA GRP
FL
Enumeration date
01/13/2006
Last updated
04/12/2013
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