Provider Demographics
NPI:1942365416
Name:NEURODIAGNOSTICS LTD.
Entity Type:Organization
Organization Name:NEURODIAGNOSTICS LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:BREEDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-326-7153
Mailing Address - Street 1:4801 N BUTLER AVE
Mailing Address - Street 2:STE. 8102
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87401-0818
Mailing Address - Country:US
Mailing Address - Phone:505-326-7153
Mailing Address - Fax:505-326-7767
Practice Address - Street 1:4801 N BUTLER AVE
Practice Address - Street 2:STE. 8102
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-0818
Practice Address - Country:US
Practice Address - Phone:505-326-7153
Practice Address - Fax:505-326-7767
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-26
Last Update Date:2007-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2000-142084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM69631Medicaid