Provider Demographics
NPI:1417497025
Name:OMNI NEURO DIAGNOSTICS
Entity Type:Organization
Organization Name:OMNI NEURO DIAGNOSTICS
Other - Org Name:OMNI MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:KOBAKOF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-396-7227
Mailing Address - Street 1:3900 S STONEBRIDGE DR.
Mailing Address - Street 2:SUITE 1501
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070
Mailing Address - Country:US
Mailing Address - Phone:214-396-7227
Mailing Address - Fax:469-453-3192
Practice Address - Street 1:3900 S STONEBRIDGE DR.
Practice Address - Street 2:SUITE 1501
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070
Practice Address - Country:US
Practice Address - Phone:214-396-7227
Practice Address - Fax:469-453-3192
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-01
Last Update Date:2018-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnosticGroup - Multi-Specialty