Provider Demographics
NPI:1235780263
Name:PERIPHERY NEUROPHYSIOLOGY
Entity Type:Organization
Organization Name:PERIPHERY NEUROPHYSIOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:TIMM
Authorized Official - Suffix:
Authorized Official - Credentials:CNIM, R EEG T
Authorized Official - Phone:801-674-9066
Mailing Address - Street 1:49 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:EPPING
Mailing Address - State:NH
Mailing Address - Zip Code:03042-3512
Mailing Address - Country:US
Mailing Address - Phone:801-674-9066
Mailing Address - Fax:
Practice Address - Street 1:49 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:EPPING
Practice Address - State:NH
Practice Address - Zip Code:03042-3512
Practice Address - Country:US
Practice Address - Phone:801-674-9066
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-20
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204R00000XAllopathic & Osteopathic PhysiciansElectrodiagnostic MedicineGroup - Multi-Specialty
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical NeurophysiologyGroup - Multi-Specialty
No246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnosticGroup - Multi-Specialty