1427101658 NPI number — NATIONAL NEURODIAGNOSTIC TECHNOLOGIES INC

Table of content: (NPI 1427101658)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427101658 NPI number — NATIONAL NEURODIAGNOSTIC TECHNOLOGIES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NATIONAL NEURODIAGNOSTIC TECHNOLOGIES INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
NEURODIAGNOSTIC TECHNOLOGIES
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1427101658
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/26/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1450
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ORANGE PARK
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32067-1450
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
904-737-5792
Provider Business Mailing Address Fax Number:
904-737-6541

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1895 KINGSLEY AVE
Provider Second Line Business Practice Location Address:
SUITE 1005
Provider Business Practice Location Address City Name:
ORANGE PARK
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32073-4466
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-737-5792
Provider Business Practice Location Address Fax Number:
904-737-6541
Provider Enumeration Date:
01/19/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MUZAURIETA
Authorized Official First Name:
AURELIO
Authorized Official Middle Name:
A.
Authorized Official Title or Position:
PRESIDENT/TECHNICAL DIRECTOR
Authorized Official Telephone Number:
904-737-5792

Provider Taxonomy Codes

  • Taxonomy code: 2084N0600X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 231H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 246ZE0600X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2471V0105X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 293D00000X , with the licence number: HCC4403 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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