Provider Demographics
NPI:1518174275
Name:REGIONAL NEURODIAGNOSTIC CENTER, P.A.
Entity Type:Organization
Organization Name:REGIONAL NEURODIAGNOSTIC CENTER, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VASISHTA
Authorized Official - Middle Name:M
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-540-0053
Mailing Address - Street 1:3139 W HOLCOMBE BLVD, BOX 574
Mailing Address - Street 2:PO BOX 574
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77025-1533
Mailing Address - Country:US
Mailing Address - Phone:281-932-0886
Mailing Address - Fax:281-540-0057
Practice Address - Street 1:2424 W HOLCOMBE BLVD STE 101
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-1933
Practice Address - Country:US
Practice Address - Phone:281-540-0053
Practice Address - Fax:281-540-0057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG4190174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXC20271Medicare UPIN
TX00956XMedicare PIN