Healthcare Provider Details

I. General information

NPI: 1518491539
Provider Name (Legal Business Name): NEWAEON LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2017
Last Update Date: 04/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 E DUNLAP AVE SUITE 1-621
PHOENIX AZ
85020-2807
US

IV. Provider business mailing address

111 E DUNLAP AVE SUITE 1-621
PHOENIX AZ
85020-2807
US

V. Phone/Fax

Practice location:
  • Phone: 623-209-1488
  • Fax: 602-633-3673
Mailing address:
  • Phone: 623-209-1488
  • Fax: 602-633-3673

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084D0003X
TaxonomyDiagnostic Neuroimaging (Psychiatry & Neurology) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State

VIII. Authorized Official

Name: ISLAM ABUJUBARA
Title or Position: OWNER
Credential: MD
Phone: 623-209-1488