East Coast Neuro LLC
NPI 1124424643ActiveOrganization· Psychiatry & Neurology, Neurology· Jacksonville, FL
Psychiatry & Neurology, Neurology in Jacksonville, Florida, registered in NPPES in November 2014. The authorized official on file is Vanessa Jaclyn Wilczak, Owner And Authorized Official. Enrolled in Medicare as part b supplier - clinic/group practice.
Overview
| NPI | 1124424643 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Nov 11, 2014 |
| Last updated in NPPES | Jan 22, 2026 |
| Certified by provider | Jan 22, 2026 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Psychiatry & Neurology, Neurology Primary | 2084N0400X | — | — |
| Chiropractor, Neurology | 111NN0400X | — | — |
| Physical Medicine & Rehabilitation | 208100000X | — | — |
| Physical Therapist | 225100000X | — | — |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Oct 9, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 4, 2026 | No match | — |
| New York OMIG · Nov 4, 2026 | No match | — |
| Ohio Medicaid · Nov 4, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 4, 2026 | No match | — |
| Washington HCA · Nov 4, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Part B Supplier - Clinic/Group Practice (FL) |
|---|
Other Psychiatry & Neurology, Neurology providers in Jacksonville
- 1801143342
- 1972610012
- 1144531021
- 1578795241
- 1588285126
- 1598995599
- 1639505035
- 1982836169
- 1235416322
- 1629201371
- 1265168090
- 1174690762
All Psychiatry & Neurology, Neurology providers in Florida →