Provider Demographics
NPI:1417165127
Name:NEUROLOGY NEURODIAGNOSTIC LAB LLC
Entity Type:Organization
Organization Name:NEUROLOGY NEURODIAGNOSTIC LAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:NASROLLAH
Authorized Official - Middle Name:
Authorized Official - Last Name:ESLAMI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-664-2967
Mailing Address - Street 1:1004 1ST ST N
Mailing Address - Street 2:SUITE330
Mailing Address - City:ALABASTER
Mailing Address - State:AL
Mailing Address - Zip Code:35007-8766
Mailing Address - Country:US
Mailing Address - Phone:205-664-2967
Mailing Address - Fax:205-664-9689
Practice Address - Street 1:1004 1ST ST N
Practice Address - Street 2:SUITE330
Practice Address - City:ALABASTER
Practice Address - State:AL
Practice Address - Zip Code:35007-8766
Practice Address - Country:US
Practice Address - Phone:205-664-2967
Practice Address - Fax:205-664-9689
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2008-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL90982084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529918500Medicaid
AL529918500Medicaid