Provider Demographics
NPI:1225172851
Name:NEUROTECH INC
Entity Type:Organization
Organization Name:NEUROTECH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEEPAK
Authorized Official - Middle Name:S
Authorized Official - Last Name:TANDON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-731-0016
Mailing Address - Street 1:125 PARKER HILL AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02120-2847
Mailing Address - Country:US
Mailing Address - Phone:617-731-0016
Mailing Address - Fax:617-739-6866
Practice Address - Street 1:125 PARKER HILL AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02120-2847
Practice Address - Country:US
Practice Address - Phone:617-731-0016
Practice Address - Fax:617-739-6866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2014-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA465652084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA102375100OtherUS DEPT OF LABOR
MA92688OtherAETNA US HEALTHACRE
MAC18116OtherBCBS
MA11151OtherHPHC NUMBER
MA130002181OtherTRAVELERS MEDICARE
MACM3196OtherRAILROAD MEDICARE
MAVC6000170977OtherCOMM OF MA
MA700883OtherTUFTS
MACM3196OtherRAILROAD MEDICARE
MAM14268Medicare ID - Type Unspecified