Jolly Neurological Clinic PC

Primary specialty

Neurology PhysicianTaxonomy code 2084N0400X

License

SJ055782 Issued in MI

Legal business name

JOLLY NEUROLOGICAL CLINIC PC

Practice address

4020 Venoy Rd
800
Wayne, MI 48184-1869

Phone

(734) 721-6001

Fax

(734) 721-6003

NPI assigned

Sep 18, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Surindar Kumar Jolly, M.D.NPI 1164479911

Title

President

Phone

(734) 721-6001

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Locations

Practitioners 2

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

• Surindar K Jolly, M.D.

  • Vascular Neurology Physician
  • Wayne, MI
  • NPI 1164479911
  Medicare reassignment Authorized official
• Jayakar Reddy Kanmantha Reddy, MD

  • Geriatric Medicine (Internal Medicine) Physician
  • Waterford Township, MI
  • NPI 1629086244
  NPD (past)

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

{
    "created_epoch": "1190073600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1239062400000",
    "number": "1407042922",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4020 VENOY RD",
            "address_2": "800",
            "city": "WAYNE",
            "state": "MI",
            "postal_code": "481841869",
            "telephone_number": "734-721-6001",
            "fax_number": "734-721-6003"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4020 VENOY RD",
            "address_2": "800",
            "city": "WAYNE",
            "state": "MI",
            "postal_code": "481841869",
            "telephone_number": "734-721-6001",
            "fax_number": "734-721-6003"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOLLY NEUROLOGICAL CLINIC PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-18",
        "last_updated": "2009-04-07",
        "status": "A",
        "authorized_official_last_name": "JOLLY",
        "authorized_official_first_name": "SURINDAR",
        "authorized_official_middle_name": "KUMAR",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "734-721-6001",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "MI",
            "license": "SJ055782",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "130H235340",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2918602",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Megan Johnson
• Raymond D Johnson, CRNA
• Tonya Lynn Johnson
• Maria Elena Johnston, DNAP, CRNA
• Carneatha Joiner
• Surindar K Jolly, M.D.
• Candice M Jones
• Janet Flomesha Jones
• Maureen Jones, OT
• Amity Jordan

• Neurology Physician in Wayne, MI
• Providers in Wayne, MI by specialty
• Neurology Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.