Organization
THE NEUROSCIENCE GROUP OF NORTHEAST WISCONSIN SC
Active
Other names
Neuroscience Group
Organization subpart
No
Provider details
NPI number
Authorized official
PHILIP YAZBAK MD (PRESIDENT)
(800) 201-1194
Entity
Organization
Contact information
Practice address
1305 W. AMERICAN DRIVE, NEENAH, WI 54956-1993
(800) 201-1194
(920) 720-7392
Mailing address
1305 W AMERICAN DRIVE, NEENAH, WI 54956-1993
(800) 201-1194
(920) 720-7392
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
—
—
2084N0400X
Neurology Physician
—
—
225100000X
Physical Therapist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000071450
MEDICARE
WI
05
—
21284100
—
WI
01
—
CD3987
RAILROAD MEDICARE
—
Enumeration date
05/18/2006
Last updated
08/16/2019
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