Provider Demographics
NPI:1669198123
Name:NERVANA NEUROMONITORING LLC
Entity type:Organization
Organization Name:NERVANA NEUROMONITORING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PASQUALE
Authorized Official - Middle Name:
Authorized Official - Last Name:PUCCIARELLI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:908-474-9444
Mailing Address - Street 1:6 FAIRVIEW TER
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08648-1084
Mailing Address - Country:US
Mailing Address - Phone:908-474-9444
Mailing Address - Fax:908-474-9440
Practice Address - Street 1:6 FAIRVIEW TER
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08648-1084
Practice Address - Country:US
Practice Address - Phone:908-474-9444
Practice Address - Fax:908-474-9440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-17
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnosticGroup - Single Specialty