1962710426 NPI number — NEUROLOGY ELECTRODIAGNOSTICS CENTER INC

Table of content: (NPI 1962710426)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962710426 NPI number — NEUROLOGY ELECTRODIAGNOSTICS CENTER INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEUROLOGY ELECTRODIAGNOSTICS CENTER 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:
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:
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NPI Number Information

NPI Number:
1962710426
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/16/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2443 COPPER CREEK DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BAY CITY
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48706-9071
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
989-737-1187
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14650 W WARREN AVE
Provider Second Line Business Practice Location Address:
SUITE 150
Provider Business Practice Location Address City Name:
DEARBORN
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48126-1799
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
313-581-0200
Provider Business Practice Location Address Fax Number:
313-582-3300
Provider Enumeration Date:
09/18/2010

Additional Information

Authorized Official

Authorized Official Last Name:
NASRALLAH
Authorized Official First Name:
KHALIL
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
989-737-1187

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  4301079672 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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