Provider Demographics
NPI:1851563464
Name:NEUROTRIX, INC.
Entity Type:Organization
Organization Name:NEUROTRIX, INC.
Other - Org Name:PRETTY SKIN AGAIN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:KEYVAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAHRDAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-869-8439
Mailing Address - Street 1:PO BOX 53225
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71135-3225
Mailing Address - Country:US
Mailing Address - Phone:318-869-8439
Mailing Address - Fax:318-797-1423
Practice Address - Street 1:1657 E 70TH ST
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-5115
Practice Address - Country:US
Practice Address - Phone:318-869-8439
Practice Address - Fax:318-797-1423
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-24
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Multi-Specialty