Provider Demographics
NPI:1457674541
Name:NEUROTESTING GROUP SC
Entity Type:Organization
Organization Name:NEUROTESTING GROUP SC
Other - Org Name:NEUROTESTING GROUP SC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DREW
Authorized Official - Middle Name:S
Authorized Official - Last Name:KANDILAKIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:312-877-0035
Mailing Address - Street 1:PO BOX 85
Mailing Address - Street 2:
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-0085
Mailing Address - Country:US
Mailing Address - Phone:312-804-8910
Mailing Address - Fax:630-390-2222
Practice Address - Street 1:1430 N ARLINGTON HEIGHTS RD
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60004-4830
Practice Address - Country:US
Practice Address - Phone:312-804-8910
Practice Address - Fax:630-390-2222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-04
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-007934246ZE0600X, 293D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnosticGroup - Multi-Specialty
No293D00000XLaboratoriesPhysiological LaboratoryGroup - Multi-Specialty