Provider Demographics
NPI:1134877020
Name:PRIMENEUROPHYSIOLOGY LLC
Entity type:Organization
Organization Name:PRIMENEUROPHYSIOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPECIALIST/TECHNOLOGIST
Authorized Official - Prefix:MR
Authorized Official - First Name:WIDNY
Authorized Official - Middle Name:
Authorized Official - Last Name:PIERRE
Authorized Official - Suffix:
Authorized Official - Credentials:SPECIALIST CNIM
Authorized Official - Phone:908-590-1917
Mailing Address - Street 1:525 ROUTE 73 N STE 104
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-3422
Mailing Address - Country:US
Mailing Address - Phone:908-590-1917
Mailing Address - Fax:
Practice Address - Street 1:525 ROUTE 73 N STE 104
Practice Address - Street 2:
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-3422
Practice Address - Country:US
Practice Address - Phone:908-590-1917
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PREMIER NEUROPHYSIOLOGY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-03-10
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnosticGroup - Single Specialty