1487024162 NPI number — ARUBAH NEUROSCIENCE INSTITUTE PLLC

Table of content: (NPI 1487024162)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487024162 NPI number — ARUBAH NEUROSCIENCE INSTITUTE PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ARUBAH NEUROSCIENCE INSTITUTE PLLC
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:
1487024162
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/03/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
214 GREEN BAY RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
THIENSVILLE
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53092-1616
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
844-458-4201
Provider Business Mailing Address Fax Number:
414-247-9004

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1701 S 23RD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT PIERCE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34950-4803
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
722-448-8600
Provider Business Practice Location Address Fax Number:
722-448-8612
Provider Enumeration Date:
10/07/2015

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SHHADEH
Authorized Official First Name:
AKRAM
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT/MEMBER
Authorized Official Telephone Number:
973-901-5457

Provider Taxonomy Codes

  • Taxonomy code: 207T00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 018549200 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".