Provider Demographics
NPI:1427101658
Name:NATIONAL NEURODIAGNOSTIC TECHNOLOGIES INC
Entity type:Organization
Organization Name:NATIONAL NEURODIAGNOSTIC TECHNOLOGIES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/TECHNICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:AURELIO
Authorized Official - Middle Name:A
Authorized Official - Last Name:MUZAURIETA
Authorized Official - Suffix:JR
Authorized Official - Credentials:BA,RVT, R NCS T
Authorized Official - Phone:904-737-5792
Mailing Address - Street 1:PO BOX 1450
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32067-1450
Mailing Address - Country:US
Mailing Address - Phone:904-737-5792
Mailing Address - Fax:904-737-6541
Practice Address - Street 1:1895 KINGSLEY AVE
Practice Address - Street 2:SUITE 1005
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-4466
Practice Address - Country:US
Practice Address - Phone:904-737-5792
Practice Address - Fax:904-737-6541
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2008-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2084N0600X, 231H00000X, 246ZE0600X, 2471V0105X
FLHCC4403293D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes293D00000XLaboratoriesPhysiological Laboratory
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical NeurophysiologyGroup - Multi-Specialty
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
No246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnosticGroup - Multi-Specialty
No2471V0105XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistVascular SonographyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE1702Medicare PIN