Provider Demographics
NPI:1083745020
Name:NEW ENGLAND NEURODIAGNOSTICS
Entity Type:Organization
Organization Name:NEW ENGLAND NEURODIAGNOSTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ASHOK
Authorized Official - Middle Name:
Authorized Official - Last Name:NIMGADE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-731-0630
Mailing Address - Street 1:101 SUMMIT AVE
Mailing Address - Street 2:UNIT B
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-2305
Mailing Address - Country:US
Mailing Address - Phone:617-731-0630
Mailing Address - Fax:
Practice Address - Street 1:101 SUMMIT AVE
Practice Address - Street 2:UNIT B
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-2305
Practice Address - Country:US
Practice Address - Phone:617-731-0630
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnosticGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAM18266OtherBLUE SHIELD
MAM18266OtherBLUE SHIELD