Provider Demographics
NPI:1629363049
Name:NEUROIMAGE INC
Entity Type:Organization
Organization Name:NEUROIMAGE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND SENIOR ADVISOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ADOLFO
Authorized Official - Middle Name:
Authorized Official - Last Name:COTTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:416-457-5699
Mailing Address - Street 1:2181 YONGE ST SUITE 801
Mailing Address - Street 2:
Mailing Address - City:TORONTO
Mailing Address - State:ONTARIO
Mailing Address - Zip Code:M4S3H7
Mailing Address - Country:CA
Mailing Address - Phone:416-457-5699
Mailing Address - Fax:416-800-8762
Practice Address - Street 1:2181 YONGE ST SUITE 801
Practice Address - Street 2:
Practice Address - City:TORONTO
Practice Address - State:ONTARIO
Practice Address - Zip Code:M4S3H7
Practice Address - Country:CA
Practice Address - Phone:416-457-5699
Practice Address - Fax:416-800-8762
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-14
Last Update Date:2011-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301098929173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty