NPIMap

Organization Active NPI

Neurologic Subspecialties Inc

  • Neurology with Special Qualifications in Child Neurology Physician
  • Scranton, PA
National Provider Identifier
1215924261
Registry record updated Mar 5, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology with Special Qualifications in Child Neurology PhysicianTaxonomy code 2084N0402X
License
PAMD026664E Issued in PA
Legal business name
NEUROLOGIC SUBSPECIALTIES INC
Practice address
311 Mulberry St
Scranton, PA 18503-1230
Phone
(570) 961-3933
NPI assigned
Oct 4, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 5, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Kenneth William Lilik, M.D.NPI 1205817699
Title
President/Owner
Phone
(570) 961-3933

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 2084N0400X PAMD026664E PA
Neurology with Special Qualifications in Child Neurology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 2084N0402X PAMD026664E PA Primary
Clinical Neurophysiology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 2084N0600X PAMD026664E PA

Addresses

Primary practice location

311 Mulberry St
Scranton, PA 18503-1230

Mailing address

311 Mulberry St
Scranton, PA 18503-1230
Phone (570) 961-3933

Other identifiers 2

IdentifierTypeStateIssuer
0010340770001MedicaidPA
0015722260001MedicaidPA

Other names 1

  • Kenneth W. Lilik, M.D. Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1128384000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1204675200000",
    "number": "1215924261",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "311 MULBERRY ST",
            "city": "SCRANTON",
            "state": "PA",
            "postal_code": "185031230",
            "telephone_number": "570-961-3933"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "311 MULBERRY ST",
            "city": "SCRANTON",
            "state": "PA",
            "postal_code": "185031230",
            "telephone_number": "570-961-3933"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEUROLOGIC SUBSPECIALTIES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-04",
        "last_updated": "2008-03-05",
        "status": "A",
        "authorized_official_last_name": "LILIK",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_middle_name": "WILLIAM",
        "authorized_official_title_or_position": "PRESIDENT/OWNER",
        "authorized_official_telephone_number": "570-961-3933",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "PA",
            "license": "PAMD026664E",
            "primary": false
        },
        {
            "code": "2084N0402X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Neurology with Special Qualifications in Child Neurology",
            "state": "PA",
            "license": "PAMD026664E",
            "primary": true
        },
        {
            "code": "2084N0600X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Clinical Neurophysiology",
            "state": "PA",
            "license": "PAMD026664E",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0010340770001",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0015722260001",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kenneth W. Lilik, M.D.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Scranton, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.