Provider Demographics
NPI:1902349889
Name:ELECTRODIAGNOSTIC AND NEUROMUSCULAR CENTER, PC
Entity type:Organization
Organization Name:ELECTRODIAGNOSTIC AND NEUROMUSCULAR CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/AUTHORIZED OFFICIAL
Authorized Official - Prefix:DR
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:ACKIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-238-3455
Mailing Address - Street 1:15 ROCHE BROTHERS WAY
Mailing Address - Street 2:SUITE 140
Mailing Address - City:NORTH EASTON
Mailing Address - State:MA
Mailing Address - Zip Code:02356-1000
Mailing Address - Country:US
Mailing Address - Phone:508-238-3455
Mailing Address - Fax:
Practice Address - Street 1:15 ROCHE BROTHERS WAY
Practice Address - Street 2:SUITE 140
Practice Address - City:NORTH EASTON
Practice Address - State:MA
Practice Address - Zip Code:02356-1000
Practice Address - Country:US
Practice Address - Phone:508-238-3455
Practice Address - Fax:508-238-2296
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-28
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty