Provider Demographics
NPI:1841301710
Name:NEUROLINK IDFT COMPANY LLC
Entity type:Organization
Organization Name:NEUROLINK IDFT COMPANY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:T
Authorized Official - Last Name:CHANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-529-1081
Mailing Address - Street 1:600 S LAKE AVE
Mailing Address - Street 2:SUITE #205
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91106-3955
Mailing Address - Country:US
Mailing Address - Phone:888-777-6639
Mailing Address - Fax:
Practice Address - Street 1:600 S LAKE AVE
Practice Address - Street 2:SUITE #205
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91106-3955
Practice Address - Country:US
Practice Address - Phone:888-777-6639
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management