Provider Demographics
NPI:1992391551
Name:CNMRI PA
Entity Type:Organization
Organization Name:CNMRI PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:RUST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-346-2491
Mailing Address - Street 1:1095 S BRADFORD ST
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19904-4141
Mailing Address - Country:US
Mailing Address - Phone:302-346-2491
Mailing Address - Fax:888-990-1108
Practice Address - Street 1:1078 S STATE ST
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19901-6902
Practice Address - Country:US
Practice Address - Phone:302-678-8100
Practice Address - Fax:877-795-9083
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-17
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty