NPIMap

Organization Active NPI

Vip Neurology

  • Neurology Physician
  • Merritt Island, FL
National Provider Identifier
1659774685
Registry record updated Dec 19, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
License
ME81256 Issued in FL
Legal business name
VIP NEUROLOGY
Practice address
300 Fortenberry Rd
Merritt Island, FL 32952-3621
Phone
(321) 325-1155
Fax
(321) 373-0055
NPI assigned
Oct 5, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 19, 2014

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

Authorized official

Name
Nikolay Stamboliyski
Title
Authorized Person
Phone
(321) 751-0041

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2084N0400X ME81256 FL Primary

Addresses

Primary practice location

300 Fortenberry Rd
Merritt Island, FL 32952-3621

Mailing address

6105 N Wickham Rd
#411682
Melbourne, FL 32941-7001

Other identifiers 1

IdentifierTypeStateIssuer
261465100MedicaidFL

National Provider Directory

National Provider Directory

Locations

6105 N Wickham Rd
Unit 411682
Melbourne, FL 32941
Phone 3213251155 ext. 7241

Practitioners & affiliated clinicians

Practitioners 15

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

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1412467200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1418947200000",
    "number": "1659774685",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6105 N WICKHAM RD",
            "address_2": "#411682",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329417001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 FORTENBERRY RD",
            "city": "MERRITT ISLAND",
            "state": "FL",
            "postal_code": "329523621",
            "telephone_number": "321-325-1155",
            "fax_number": "321-373-0055"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VIP NEUROLOGY",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-10-05",
        "last_updated": "2014-12-19",
        "status": "A",
        "authorized_official_last_name": "STAMBOLIYSKI",
        "authorized_official_first_name": "NIKOLAY",
        "authorized_official_title_or_position": "AUTHORIZED PERSON",
        "authorized_official_telephone_number": "321-751-0041"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "FL",
            "license": "ME81256",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "261465100",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Merritt Island, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2014; 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.