MEDICARE: NEURO DIAGNOSTIC CENTER INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR0208X	Mobile Radiology Clinic/Center

General Provider Information

NPI Number	:	1568631331
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEURO DIAGNOSTIC CENTER INC

Provider Business Mailing Address
First Line	:	1405 W KENNETH RD
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91201-1421
Country	:	US
Telephone Number	:	818-240-9639
Fax Number	:	818-240-9739

Provider Business Practice Location Address
First Line	:	1405 W KENNETH RD
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91201-1421
Country	:	US
Telephone Number	:	818-240-9639
Fax Number	:	818-240-9739

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SHUSHANIK KHEROYAN
Credential	:
Telephone Number	:	818-240-9639

Provider Enumeration Date	:	02/26/2008
Last Update Date	:	02/26/2008

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