Provider Demographics
NPI:1689063208
Name:ACTIVE NEUROMONITORING LLC
Entity Type:Organization
Organization Name:ACTIVE NEUROMONITORING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LATOYA
Authorized Official - Middle Name:
Authorized Official - Last Name:FRIDAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-446-7446
Mailing Address - Street 1:1451 W CYPRESS CREEK RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33309-1961
Mailing Address - Country:US
Mailing Address - Phone:954-446-7446
Mailing Address - Fax:
Practice Address - Street 1:1451 W CYPRESS CREEK RD
Practice Address - Street 2:SUITE 300
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33309-1961
Practice Address - Country:US
Practice Address - Phone:954-446-7446
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-20
Last Update Date:2015-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical TechnologistGroup - Single Specialty