Provider Demographics
NPI:1801418140
Name:NEUROGANICS LLC
Entity Type:Organization
Organization Name:NEUROGANICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF SCIENCE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:CHANNING
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:720-431-3495
Mailing Address - Street 1:10190 BANNOCK ST STE 102
Mailing Address - Street 2:
Mailing Address - City:NORTHGLENN
Mailing Address - State:CO
Mailing Address - Zip Code:80260-6052
Mailing Address - Country:US
Mailing Address - Phone:720-431-3495
Mailing Address - Fax:
Practice Address - Street 1:10190 BANNOCK ST STE 102
Practice Address - Street 2:
Practice Address - City:NORTHGLENN
Practice Address - State:CO
Practice Address - Zip Code:80260-6052
Practice Address - Country:US
Practice Address - Phone:720-431-3495
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-09
Last Update Date:2020-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory MedicineGroup - Multi-Specialty