Provider Demographics
NPI:1154624823
Name:NEURO-DIAGNOSTIC INSTITUTE LLC
Entity type:Organization
Organization Name:NEURO-DIAGNOSTIC INSTITUTE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SIMON
Authorized Official - Middle Name:
Authorized Official - Last Name:ZIMNOWODZKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-471-8587
Mailing Address - Street 1:1201 HOHLFELDER RD
Mailing Address - Street 2:100
Mailing Address - City:GLENCOE
Mailing Address - State:IL
Mailing Address - Zip Code:60022-1020
Mailing Address - Country:US
Mailing Address - Phone:847-471-8587
Mailing Address - Fax:
Practice Address - Street 1:1201 HOHLFELDER RD
Practice Address - Street 2:100
Practice Address - City:GLENCOE
Practice Address - State:IL
Practice Address - Zip Code:60022-1020
Practice Address - Country:US
Practice Address - Phone:847-471-8587
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-17
Last Update Date:2011-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360663132084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty