Organization
VIP NEUROLOGY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NIKOLAY STAMBOLIYSKI (AUTHORIZED PERSON)
(321) 751-0041
Entity
Organization
Contact information
Practice address
300 FORTENBERRY RD, MERRITT ISLAND, FL 32952-3621
(321) 325-1155
(321) 373-0055
Mailing address
6105 N WICKHAM RD, #411682, MELBOURNE, FL 32941-7001
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
ME81256
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
261465100
—
FL
Enumeration date
10/05/2014
Last updated
12/19/2014
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