JOLLY NEUROLOGICAL CLINIC PC (NPI# 1407042922) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1407042922 |
| Entity Type | Organization |
| Organization Name | JOLLY NEUROLOGICAL CLINIC PC |
| Practice Address |
4020 Venoy Rd 800 Wayne MI 48184-1869 |
| Practice Telephone | 7347216001 |
| Practice Fax Number | 7347216003 |
| Mailing Telephone | 7347216001 |
| Mailing Fax Number | 7347216003 |
| Enumeration Date | 2007-09-18 |
| Last Update Date | 2009-04-07 |
| Authorized Official Name | DR. SURINDAR KUMAR JOLLY (PRESIDENT) |
| Authorized Official Telephone | 7347216001 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2084N0400X |
Psychiatry & Neurology Specialization: Neurology |
SJ055782 | MI | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MI | BLUE CROSS BLUE SHIELD | 130H235340 | 01 |
| MI | 2918602 | 05 |
| Street Address |
4020 VENOY RD 800 |
| City | WAYNE |
| State | MI |
| Zip Code | 48184-1869 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194794412 | Adilakshmi Kaza | Obstetrics & Gynecology | 4020 Venoy Rd, Suite 400, Wayne, MI 48184-1869 | 2006-03-17 |
| 1477711414 | Chawki M Fakih | Pharmacist | 4020 Venoy Rd, Wayne, MI 48184-1869 | 2008-05-27 |
| 1932237864 | Stars Investment Inc | Pharmacy | 4020 Venoy Rd, Suite 900, Wayne, MI 48184-1869 | 2007-03-01 |
| 1760527659 | Stars Investment Inc | Public Health or Welfare | 4020 Venoy Rd, Ste 200a, Wayne, MI 48184-1869 | 2007-02-20 |
| 1801969472 | Luningning V Regalado | Internal Medicine | 4020 Venoy Rd, Wayne, MI 48184-1869 | 2006-11-15 |
| 1275618027 | Michigan Cardiology Associates PC | Internal Medicine | 4020 Venoy Rd, Suite 200, Wayne, MI 48184-1869 | 2006-10-26 |
| 1699866509 | Rajesh Chander Gulati | Internal Medicine | 4020 Venoy Rd, Suite 200, Wayne, MI 48184-1869 | 2006-09-27 |
| 1164479911 | Surindar K Jolly | Psychiatry & Neurology | 4020 Venoy Rd, Ste#800, Wayne, MI 48184-1869 | 2006-05-27 |
| 1013967819 | John W Armstead | Obstetrics & Gynecology | 4020 Venoy Rd, Suite 400, Wayne, MI 48184-1869 | 2006-05-11 |
| 1780645036 | Mansoor G Naini | Internal Medicine | 4020 Venoy Rd, Suite 200, Wayne, MI 48184-1869 | 2006-03-28 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215570932 | Wayne Rx | Pharmacy | 4603 Wayne Rd, Wayne, MI 48184 | 2019-10-25 |
| 1669902433 | Randi Oswald | Massage Therapist | 34336 Richard St., Wayne, MI 48184 | 2017-06-14 |
| 1306393822 | Amanda Anastasoff | Technician, Other | 35640 West Michigan Avenue, Wayne, MI 48184 | 2016-09-01 |
| 1871941302 | Christopher Schrimscher | Technician, Other | 34560 Michigan Avenue W, Wayne, MI 48184 | 2016-05-25 |
| 1659757334 | Anna Bondy | Technician, Other | 35640 Michigan Ave. West, Wayne, MI 48184 | 2015-08-05 |
| 1992184550 | Carrie Walrath | Community Health Worker | 4234 Niagara, Wayne, MI 48184 | 2015-05-28 |
| 1588043459 | Suzanne Cutlip | Case Manager/Care Coordinator | 35425 Michigan Ave. W. Suite 1, Wayne, MI 48184 | 2015-05-26 |
| 1285021295 | Alicia Allen | Technician, Other | 35640 Michigan Avenue West, Wayne, MI 48184 | 2015-04-17 |
| 1164843850 | Julia Krivoy | Nurse Anesthetist, Certified Registered | 33155 Annapolis St., Beaumont/oakwood Hospital - Wayne, Wayne, MI 48184 | 2013-12-23 |
| 1992130553 | One Stop Pharmacy LLC | Pharmacy | 33950 Van Born Rd, Wayne, MI 48184 | 2013-09-13 |
| Find all providers in zip 48184 | ||||
| Taxonomy Code | 2084N0400X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Psychiatry & Neurology |
| Specialization | Neurology |
| A Neurologist specializes in the diagnosis and treatment of diseases or impaired function of the brain, spinal cord, peripheral nerves, muscles, autonomic nervous system, and blood vessels that relate to these structures. |
| Notes: Source: The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730116690 | Ann Marie Madaline Mascellino | Psychiatry & Neurology | 1680 Route 23 Ste 300, Wayne, NJ 07470-7520 | 2006-06-27 |
| 1932108388 | Ranajit Sil | Psychiatry & Neurology | 34815 W Michigan Ave, Ste C, Wayne, MI 48184-1799 | 2005-07-19 |
| 1609297738 | Wayne Neurological Associates,llc | Psychiatry & Neurology | 401 Hamburg Tpke, Suite 208, Wayne, NJ 07470-2154 | 2013-12-16 |
| 1548461734 | Shamael Haque | Psychiatry & Neurology | 33155 Annapolis St, Wayne, MI 48184-2405 | 2007-05-29 |
| 1275741647 | Matthew C. Holtzman | Psychiatry & Neurology | 34815 W Michigan Ave, C, Wayne, MI 48184-1799 | 2007-05-18 |
| 1770623621 | Cnos, PC | Psychiatry & Neurology | 1200 Providence Rd, Wayne, NE 68787-1212 | 2007-02-08 |
| 1649331679 | North Jersey Neurologic Associates | Psychiatry & Neurology | 1680 Route 23 Ste 300, Wayne, NJ 07470-7520 | 2006-12-13 |
| 1205907086 | Robert Austin Wagner | Psychiatry & Neurology | 1680 Route 23 Ste 300, Wayne, NJ 07470-7520 | 2006-11-13 |
| 1548344195 | David Safar | Psychiatry & Neurology | 2025 Hamburg Tpke, Suite M, Wayne, NJ 07470-6260 | 2006-10-24 |
| 1376643973 | Frank Louis Gazzillo Jr. | Psychiatry & Neurology | 220 Hamburg Tpke, Suite 16, Wayne, NJ 07470-2110 | 2006-09-23 |
| Find all providers in WAYNE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.