| Neuromedical Diagnostic Medical Group | |
|
1045 Atlantic Ave 719 Long Beach CA 90813-3412 | |
| (562) 591-1324 | |
| (562) 437-1054 |
| Full Name | Neuromedical Diagnostic Medical Group |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 1045 Atlantic Ave, Long Beach, California |
| Authorized Official Name and Position | Panos Z Marmarelis (PARTNER) |
| Authorized Official Contact | 5625911324 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Neuromedical Diagnostic Medical Group 1045 Atlantic Ave 719 Long Beach CA 90813-3412 Ph: (562) 591-1324 | Neuromedical Diagnostic Medical Group 1045 Atlantic Ave 719 Long Beach CA 90813-3412 Ph: (562) 591-1324 |
| NPI Number | 1033116546 |
|---|---|
| Provider Enumeration Date | 06/30/2005 |
| Last Update Date | 07/21/2022 |
| Medicare PECOS PAC ID | 4284609330 |
|---|---|
| Medicare Enrollment ID | O20040831001597 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033116546 | NPI | - | NPPES |
| CP2733 | Other | CA | RAIL ROAD MEDICARE |
| W6126 | Other | CA | PTAN PROVIDER IDENTIFIER, MEDICARE |
| GR0004090 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | (California) | Primary |
| Provider Name | Panos Z Marmarelis |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1275585622 PECOS PAC ID: 5193790244 Enrollment ID: I20090204000054 |
| Provider Name | Randolph B Shey |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1417997636 PECOS PAC ID: 8820063977 Enrollment ID: I20090204000076 |
| Provider Name | Banafsheh Yafeh |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1760677892 PECOS PAC ID: 9032390380 Enrollment ID: I20110721000295 |
| Provider Name | Rose Mary Berman |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1225113830 PECOS PAC ID: 9931365301 Enrollment ID: I20120730000670 |
| Provider Name | Elinor Y. Lin |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1164683876 PECOS PAC ID: 2860634474 Enrollment ID: I20130812000215 |
| Provider Name | Parissa I Vassef |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1356630370 PECOS PAC ID: 7810282563 Enrollment ID: I20160819002370 |
| Provider Name | Saheil S Aboutalib |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1548551112 PECOS PAC ID: 0042590895 Enrollment ID: I20161213001668 |
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