Provider Demographics
NPI:1922376201
Name:NEOSTART CORP
Entity Type:Organization
Organization Name:NEOSTART CORP
Other - Org Name:AGA CLINICAL TRIALS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:XIMENA
Authorized Official - Last Name:GRABER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-819-1551
Mailing Address - Street 1:900 W 49TH ST
Mailing Address - Street 2:SUITE #430
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-3402
Mailing Address - Country:US
Mailing Address - Phone:305-819-1551
Mailing Address - Fax:305-819-1159
Practice Address - Street 1:900 W 49TH ST
Practice Address - Street 2:SUITE #430
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-3402
Practice Address - Country:US
Practice Address - Phone:305-819-1551
Practice Address - Fax:305-819-1159
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-01
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS8448261QR1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1100XAmbulatory Health Care FacilitiesClinic/CenterResearch