Provider Demographics
NPI:1447560677
Name:NEUROPSYCHOLOGY AND BRAIN INJURY REHABILITATION SERVICES, PC
Entity Type:Organization
Organization Name:NEUROPSYCHOLOGY AND BRAIN INJURY REHABILITATION SERVICES, PC
Other - Org Name:EUGENE B. PIASETSKY, PHD, PC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:B
Authorized Official - Last Name:PIASETSKY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:203-230-2199
Mailing Address - Street 1:2558 WHITNEY AVE
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06518-3046
Mailing Address - Country:US
Mailing Address - Phone:203-230-2199
Mailing Address - Fax:203-230-2242
Practice Address - Street 1:2558 WHITNEY AVE
Practice Address - Street 2:
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06518-3046
Practice Address - Country:US
Practice Address - Phone:203-230-2199
Practice Address - Fax:203-230-2242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-21
Last Update Date:2010-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT01445103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty