Organization
NEUROLOGY & SPINE DISORDERS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. AL FALCO (CEO)
(386) 274-7118
Entity
Organization
Contact information
Practice address
5111 S RIDGEWOOD AVE, SUITE 102, PORT ORANGE, FL 32127-5169
(386) 763-4484
(386) 763-1288
Mailing address
1673 MASON AVE, SUITE 107, DAYTONA BEACH, FL 32117-5515
(386) 274-7118
(386) 274-6173
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
ME46005
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000EZ
BLUE CROSS BLUE SHIELD
FL
01
—
DQ2689
RAILROAD MEDICARE
FL
Enumeration date
03/03/2010
Last updated
09/08/2010
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