Provider Demographics
NPI:1972864007
Name:NEUROSOMNOLOGY PA
Entity Type:Organization
Organization Name:NEUROSOMNOLOGY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:J
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-808-7381
Mailing Address - Street 1:5611 SILVERTHORN GLEN DR
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77379-3517
Mailing Address - Country:US
Mailing Address - Phone:281-808-7381
Mailing Address - Fax:713-694-6067
Practice Address - Street 1:5611 SILVERTHORN GLEN DR
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77379-3517
Practice Address - Country:US
Practice Address - Phone:281-808-7381
Practice Address - Fax:713-694-6067
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-05
Last Update Date:2012-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN0433174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty