Headache Institute of Tidewater LLC

Primary specialty

Neurology PhysicianTaxonomy code 2084N0400X

Legal business name

HEADACHE INSTITUTE OF TIDEWATER LLC

Practice address

780 Lynnhaven Pkwy
Suite 285
Virginia Beach, VA 23452-7332

Phone

(757) 368-1891

Fax

(757) 368-4041

NPI assigned

Jun 1, 2009

Last updated

Jun 1, 2009By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Neil L Pugach, M.D.

Title

Physician

Phone

(757) 368-1891

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1243814400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1243814400000",
    "number": "1235365503",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "780 LYNNHAVEN PKWY",
            "address_2": "SUITE 285",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234527332",
            "telephone_number": "757-368-1891",
            "fax_number": "757-368-4041"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "780 LYNNHAVEN PKWY",
            "address_2": "SUITE 285",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234527332",
            "telephone_number": "757-368-1891",
            "fax_number": "757-368-4041"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEADACHE INSTITUTE OF TIDEWATER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-06-01",
        "last_updated": "2009-06-01",
        "status": "A",
        "authorized_official_last_name": "PUGACH",
        "authorized_official_first_name": "NEIL",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "757-368-1891",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2009; 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.