Provider Demographics
NPI:1396075933
Name:THE INSTITUTE FOR NEURODEGENERATIVE DISORDERS
Entity type:Organization
Organization Name:THE INSTITUTE FOR NEURODEGENERATIVE DISORDERS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:M
Authorized Official - Last Name:MARIOTTI
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:203-401-4351
Mailing Address - Street 1:60 TEMPLE ST
Mailing Address - Street 2:SUITE 8B
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06510-2716
Mailing Address - Country:US
Mailing Address - Phone:203-401-4300
Mailing Address - Fax:203-401-4304
Practice Address - Street 1:60 TEMPLE ST
Practice Address - Street 2:SUITE 8B
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510-2716
Practice Address - Country:US
Practice Address - Phone:203-401-4300
Practice Address - Fax:203-401-4304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-04
Last Update Date:2010-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084D0003XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyDiagnostic NeuroimagingGroup - Multi-Specialty
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty