1205137056 NPI number — NEUROPSYCHOLOGY SERVICES, PC

Table of content: (NPI 1205137056)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205137056 NPI number — NEUROPSYCHOLOGY SERVICES, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEUROPSYCHOLOGY SERVICES, PC
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:
Provider Other Organization Name Type Code:
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:
1205137056
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/10/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 605
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH GRAFTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01536-0605
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-393-3820
Provider Business Mailing Address Fax Number:
508-393-3814

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
96 W MAIN ST
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
NORTHBOROUGH
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01532-3810
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-393-3820
Provider Business Practice Location Address Fax Number:
508-393-3814
Provider Enumeration Date:
11/10/2010

Additional Information

Authorized Official

Authorized Official Last Name:
DECKEL
Authorized Official First Name:
ALBERT
Authorized Official Middle Name:
WALLACE
Authorized Official Title or Position:
NEUROPSYCHOLOGIST
Authorized Official Telephone Number:
508-393-3820

Provider Taxonomy Codes

  • Taxonomy code: 261QM0850X , with the licence number:  8183 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QM0855X , with the licence number: 8183 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 0522791 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




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