EAST COAST NEURO SPINE CLINIC, LLC (NPI# 1962049163) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1962049163 |
| Entity Type | Organization |
| Organization Name | EAST COAST NEURO SPINE CLINIC, LLC |
| Other Organization Name | BRAIN AND SPINE CLINIC |
| Practice Address |
1601 S Apollo Blvd Ste C Melbourne FL 32901-4484 |
| Practice Telephone | 3213277797 |
| Practice Fax Number | 3213277789 |
| Mailing Telephone | 3213277797 |
| Mailing Fax Number | 3213277789 |
| Enumeration Date | 2019-12-06 |
| Last Update Date | 2020-01-23 |
| Authorized Official Name | JACOB JANUSZEWSKI (OWNER) |
| Authorized Official Telephone | 3214062747 |
| Authorized Official Credential | DO |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207T00000X | Neurological Surgery | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Brain and Complex Spine Clinic | Doing Business As Name - Organization |
| Brain and Spine Clinic | Doing Business As Name - Organization |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 2065 Highway A1a Apt 1704, Indian Harbour Beach, FL 329371812 | 9175021112 | 8448953070 |
| Street Address |
1601 S APOLLO BLVD STE C |
| City | MELBOURNE |
| State | FL |
| Zip Code | 32901-4484 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740892413 | Jessica Cheperuk | Registered Nurse | 1601 S Apollo Blvd Ste C, Melbourne, FL 32901-4484 | 2020-08-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467062943 | George Pappas | Anesthesiologist Assistant | 1775 W. Hibiscus Blvd., Ste 215, Melbourne, FL 32901 | 2020-08-09 |
| 1124676820 | Abbi Dell Lee | Behavioral Analyst | 3251 Engineering St, Melbourne, FL 32901 | 2019-08-27 |
| 1750856878 | Jeffrey Michael Cavanagh | Behavior Technician | 3251 Engineering Street, Melbourne, FL 32901 | 2018-10-04 |
| 1740766021 | Amanda Miller | Behavior Technician | 1885 W Hibiscus Blvd, Melbourne, FL 32901 | 2018-07-19 |
| 1396244406 | Dragen II LLC | Urology | 129 W Hibiscus Blvd Ste D, Melbourne, FL 32901 | 2018-02-03 |
| 1225550692 | Cabrit Psychotherapy Services LLC | Marriage & Family Therapist | 100 Rialto Place, Suite 700, Melbourne, FL 32901 | 2017-07-07 |
| 1487188058 | Project Response, Inc. | Clinic/Center | 747 S. Apollo Boulevard, Melbourne, FL 32901 | 2017-04-20 |
| 1184174575 | Paulette Swanson | Physical Therapist | 611 East Sheridan Rd, Melbourne, FL 32901 | 2016-10-10 |
| 1841747839 | Nicholas Wilson | Social Worker | 3661 S. Babcock St., Melbourne, FL 32901 | 2016-09-07 |
| 1467804278 | Nickolas Hetherington | Occupational Therapist | 1900 S Harbor City Blvd Ste 108, Melbourne, FL 32901 | 2016-07-05 |
| Find all providers in zip 32901 | ||||
| Taxonomy Code | 207T00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Neurological Surgery |
| A neurological surgeon provides the operative and non-operative management (i.e., prevention, diagnosis, evaluation, treatment, critical care, and rehabilitation) of disorders of the central, peripheral, and autonomic nervous systems, including their supporting structures and vascular supply; the evaluation and treatment of pathological processes which modify function or activity of the nervous system; and the operative and non-operative management of pain. A neurological surgeon treats patients with disorders of the nervous system; disorders of the brain, meninges, skull, and their blood supply, including the extracranial carotid and vertebral arteries; disorders of the pituitary gland; disorders of the spinal cord, meninges, and vertebral column, including those which may require treatment by spinal fusion or instrumentation; and disorders of the cranial and spinal nerves throughout their distribution. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added] Additional Resources: American Board of Neurological Surgery, 2007. http://www.abns.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Neurological Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245775725 | Godefroy Hardy St-pierre | Neurological Surgery | 2222 S. Harbor City Blvd., Suite 610, Melbourne, FL 32901-5591 | 2016-12-20 |
| 1851347678 | Rafael Allende | Neurological Surgery | 1251 Hickory St, Melbourne, FL 32901-3221 | 2006-05-25 |
| 1609840941 | Jonathan T. Paine | Neurological Surgery | 1305 Valentine St, Melbourne, FL 32901-3127 | 2006-02-14 |
| 1962409169 | Mark A Fulton | Neurological Surgery | 1251 S Hickory St, Melbourne, FL 32901-3221 | 2005-07-01 |
| 1235407206 | Basil C Theodotou Md Pa | Neurological Surgery | 32 Suntree Pl, Melbourne, FL 32940-7689 | 2011-12-06 |
| 1457628570 | F .matuk M.d.,p.a. | Neurological Surgery | 32 Suntree Pl, Melbourne, FL 32940-7689 | 2011-11-17 |
| 1578846564 | First Choice Medical Group of Brevard LLC | Neurological Surgery | 709 S Harbor City Blvd Ste 100, Melbourne, FL 32901-1936 | 2011-09-26 |
| 1053610808 | Jacob Januszewski | Neurological Surgery | 2222 S Harbor City Blvd Ste 610, Melbourne, FL 32901-5591 | 2011-03-18 |
| 1821002684 | Wesley E Griffitt | Neurological Surgery | 1251 Hickory St, Melbourne, FL 32901-3221 | 2006-07-28 |
| 1932173283 | Jonathan T Paine Md Pa | Neurological Surgery | 1305 Valentine St, Melbourne, FL 32901-3127 | 2006-02-14 |
| Find all providers in MELBOURNE | ||||
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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.