Provider Demographics
NPI:1538677588
Name:PEAK NEUROPHYSIOLOGY GROUP, LLC
Entity Type:Organization
Organization Name:PEAK NEUROPHYSIOLOGY GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:RILEY
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CNIM
Authorized Official - Phone:518-727-2238
Mailing Address - Street 1:5 FRANCIS PL
Mailing Address - Street 2:
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-1613
Mailing Address - Country:US
Mailing Address - Phone:518-727-2238
Mailing Address - Fax:
Practice Address - Street 1:5 FRANCIS PL
Practice Address - Street 2:
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110-1613
Practice Address - Country:US
Practice Address - Phone:518-727-2238
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-11
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NA174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty