Organization · NPI-2
Neuro Iom Services INC
Psychiatry & Neurology, Neurology · Lake Worth, FL
NPI number1104980648
StatusActive
Last updated in NPPESJul 17, 2014
Details
- NPI
- 1104980648
- Entity type
- Organization (NPI-2)
- Legal business name
- Neuro Iom Services INC
- Organization subpart
- No
- Enumeration date
- Dec 20, 2006
- Last updated
- Jul 17, 2014
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology, Neurology | ME0044967 | FL | Yes |
Practice location
1926 10th Ave NSuite 105
Lake Worth, FL 33461-3369
Phone 561-540-4458 · Fax 561-540-5939
Mailing address
11011 Mccormick Rd.Suite 200
Hunt Valley, MD 21031-8619
Phone 410-666-2588 · Fax 443-403-0207
Authorized official
Mary Johnson
Coo
4106662588
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