Provider Demographics
NPI:1396828448
Name:NEUROTECH INC
Entity Type:Organization
Organization Name:NEUROTECH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCIAL OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:W
Authorized Official - Last Name:LASKEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-269-0500
Mailing Address - Street 1:930 KINGSLEY AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073
Mailing Address - Country:US
Mailing Address - Phone:904-269-0500
Mailing Address - Fax:904-269-9805
Practice Address - Street 1:930 KINGSLEY AVE
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073
Practice Address - Country:US
Practice Address - Phone:904-269-0500
Practice Address - Fax:904-269-9805
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty