Provider Demographics
NPI:1528373578
Name:TRI-STATE EEG LLC
Entity Type:Organization
Organization Name:TRI-STATE EEG LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:PEPI
Authorized Official - Middle Name:
Authorized Official - Last Name:DAKOV
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-614-4138
Mailing Address - Street 1:6260 99TH ST APT 1227
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-6030
Mailing Address - Country:US
Mailing Address - Phone:347-614-1848
Mailing Address - Fax:347-665-1939
Practice Address - Street 1:6260 99TH ST APT 1227
Practice Address - Street 2:
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-6030
Practice Address - Country:US
Practice Address - Phone:347-614-1848
Practice Address - Fax:347-665-1939
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-15
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZE0500XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherEEGGroup - Single Specialty