Provider Demographics
NPI:1629152640
Name:NEURODYME DIAGNOSTICS
Entity Type:Organization
Organization Name:NEURODYME DIAGNOSTICS
Other - Org Name:NEURODYME DIAGNOSTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:HAYDEN
Authorized Official - Last Name:ROSE
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:832-876-7084
Mailing Address - Street 1:3422 GARDEN SHADOW LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77018-6346
Mailing Address - Country:US
Mailing Address - Phone:832-876-7084
Mailing Address - Fax:
Practice Address - Street 1:3422 GARDEN SHADOW LN
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77018-6346
Practice Address - Country:US
Practice Address - Phone:832-876-7084
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnosticGroup - Single Specialty