Provider Demographics
NPI:1174043525
Name:DYAMIC NEUROMONITORING, LLC
Entity Type:Organization
Organization Name:DYAMIC NEUROMONITORING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RON
Authorized Official - Middle Name:
Authorized Official - Last Name:NEZAT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-886-5440
Mailing Address - Street 1:PO BOX 91180
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70509-1180
Mailing Address - Country:US
Mailing Address - Phone:337-886-5440
Mailing Address - Fax:337-886-9983
Practice Address - Street 1:208 W GLORIA SWITCH RD
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70507-3409
Practice Address - Country:US
Practice Address - Phone:337-886-5440
Practice Address - Fax:337-886-9983
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-26
Last Update Date:2017-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnosticGroup - Single Specialty