Provider Demographics
NPI:1609409150
Name:BRAIN MODULATION SERVICES, LLC
Entity Type:Organization
Organization Name:BRAIN MODULATION SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GONZALO
Authorized Official - Middle Name:
Authorized Official - Last Name:LAJE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-576-6044
Mailing Address - Street 1:5480 WISCONSIN AVE STE 223
Mailing Address - Street 2:
Mailing Address - City:CHEVY CHASE
Mailing Address - State:MD
Mailing Address - Zip Code:20815-3503
Mailing Address - Country:US
Mailing Address - Phone:301-576-6044
Mailing Address - Fax:301-576-1645
Practice Address - Street 1:5480 WISCONSIN AVE STE 223
Practice Address - Street 2:
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815-3503
Practice Address - Country:US
Practice Address - Phone:301-576-6044
Practice Address - Fax:301-576-1645
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-12
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty