Provider Demographics
NPI:1851937981
Name:NEURODIAGNOSTICS, INC.
Entity type:Organization
Organization Name:NEURODIAGNOSTICS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:P
Authorized Official - Last Name:TANICO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-294-7026
Mailing Address - Street 1:12441 PARKLAWN DR STE 2A
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-2180
Mailing Address - Country:US
Mailing Address - Phone:301-294-7026
Mailing Address - Fax:301-576-8629
Practice Address - Street 1:12441 PARKLAWN DR STE 2A
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-2180
Practice Address - Country:US
Practice Address - Phone:301-294-7026
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-25
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes291U00000XLaboratoriesClinical Medical LaboratoryGroup - Multi-Specialty
No207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory MedicineGroup - Multi-Specialty
No207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
21D2130277OtherFEDERAL CLIA NUMBER