Provider Demographics
NPI:1285943894
Name:NEURO CONNECT
Entity type:Organization
Organization Name:NEURO CONNECT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:LEA
Authorized Official - Last Name:RUSSO
Authorized Official - Suffix:
Authorized Official - Credentials:REEGT
Authorized Official - Phone:808-754-7967
Mailing Address - Street 1:PO BOX 851
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-0851
Mailing Address - Country:US
Mailing Address - Phone:808-754-7967
Mailing Address - Fax:808-930-5551
Practice Address - Street 1:1188 BISHOP ST STE 607
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-3302
Practice Address - Country:US
Practice Address - Phone:808-754-7967
Practice Address - Fax:808-356-0771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-29
Last Update Date:2013-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZE0500XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherEEGGroup - Single Specialty