Organization
NEUROLOGIC SUBSPECIALTIES INC
Active
Other names
Kenneth W. Lilik, M.D.
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KENNETH WILLIAM LILIK M.D. (PRESIDENT/OWNER)
(570) 961-3933
Entity
Organization
Contact information
Practice address
311 MULBERRY ST, SCRANTON, PA 18503-1230
(570) 961-3933
Mailing address
311 MULBERRY ST, SCRANTON, PA 18503-1230
(570) 961-3933
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
PAMD026664E
PA
2084N0402X
Neurology with Special Qualifications in Child Neurology Physician
Primary
PAMD026664E
PA
2084N0600X
Clinical Neurophysiology Physician
PAMD026664E
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0010340770001
—
PA
05
—
0015722260001
—
PA
Enumeration date
10/04/2005
Last updated
03/05/2008
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