1558820787 NPI number — NEUROSUITE LLC

Table of content: (NPI 1558820787)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558820787 NPI number — NEUROSUITE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEUROSUITE LLC
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:
1558820787
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/14/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
614 ONEIDA ST NE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WASHINGTON
Provider Business Mailing Address State Name:
DC
Provider Business Mailing Address Postal Code:
20011-1640
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
202-886-7675
Provider Business Mailing Address Fax Number:
202-810-9113

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
614 ONEIDA ST NE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
DC
Provider Business Practice Location Address Postal Code:
20011-1640
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
202-886-7675
Provider Business Practice Location Address Fax Number:
202-810-9113
Provider Enumeration Date:
03/18/2019

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GASKINS
Authorized Official First Name:
PETER
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/THERAPIST
Authorized Official Telephone Number:
202-794-7495

Provider Taxonomy Codes

  • Taxonomy code: 225XN1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QX0100X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 424856200 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".