Provider Demographics
NPI:1699744508
Name:NEUROMONITORING MEDICAL SERVICES, LLC
Entity type:Organization
Organization Name:NEUROMONITORING MEDICAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ONILE
Authorized Official - Middle Name:VAITKUS
Authorized Official - Last Name:SESTOKAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-565-7726
Mailing Address - Street 1:15 CHRISTINE LN
Mailing Address - Street 2:
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-1519
Mailing Address - Country:US
Mailing Address - Phone:610-565-7726
Mailing Address - Fax:
Practice Address - Street 1:15 CHRISTINE LN
Practice Address - Street 2:
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-1519
Practice Address - Country:US
Practice Address - Phone:610-565-7726
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-14
Last Update Date:2009-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD056902-L207R00000X
CT42740207R00000X
DEC1-0007370207R00000X
NJ25MA07790400207R00000X
NY231589-1207R00000X
OH85370207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA111064Medicare PIN