Provider Demographics
NPI:1518491539
Name:NEWAEON LLC
Entity Type:Organization
Organization Name:NEWAEON LLC
Other - Org Name:ARIZONA NEURODIAGNOSTIC SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ISLAM
Authorized Official - Middle Name:
Authorized Official - Last Name:ABUJUBARA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:623-209-1488
Mailing Address - Street 1:111 E DUNLAP AVE
Mailing Address - Street 2:SUITE 1-621
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-2807
Mailing Address - Country:US
Mailing Address - Phone:623-209-1488
Mailing Address - Fax:602-633-3673
Practice Address - Street 1:111 E DUNLAP AVE
Practice Address - Street 2:SUITE 1-621
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-2807
Practice Address - Country:US
Practice Address - Phone:623-209-1488
Practice Address - Fax:602-633-3673
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-17
Last Update Date:2017-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084D0003XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyDiagnostic NeuroimagingGroup - Single Specialty
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty