Provider Demographics
NPI:1134277189
Name:NEURO PHYSIOLOGICAL ASSOCIATES
Entity type:Organization
Organization Name:NEURO PHYSIOLOGICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAN
Authorized Official - Middle Name:W
Authorized Official - Last Name:JOACHIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:985-845-4595
Mailing Address - Street 1:804 HEAVENS DRIVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MENDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70471
Mailing Address - Country:US
Mailing Address - Phone:985-845-4595
Mailing Address - Fax:985-845-8810
Practice Address - Street 1:804 HEAVENS DRIVE
Practice Address - Street 2:SUITE 201
Practice Address - City:MENDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70471
Practice Address - Country:US
Practice Address - Phone:985-845-4595
Practice Address - Fax:985-845-8810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical NeurophysiologyGroup - Single Specialty