Provider Demographics
NPI:1427412956
Name:NEUROMONITORING SPECIALISTS LLC
Entity type:Organization
Organization Name:NEUROMONITORING SPECIALISTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-807-5166
Mailing Address - Street 1:3610 MYSTIC VALLEY PKWY
Mailing Address - Street 2:N602
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-5757
Mailing Address - Country:US
Mailing Address - Phone:917-807-5166
Mailing Address - Fax:
Practice Address - Street 1:3610 MYSTIC VALLEY PKWY
Practice Address - Street 2:N602
Practice Address - City:MEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02155-5757
Practice Address - Country:US
Practice Address - Phone:917-807-5166
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-11
Last Update Date:2016-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnosticGroup - Single Specialty