Healthcare Provider Details

I. General information

NPI: 1811855836
Provider Name (Legal Business Name): NEUROTAP HEALTH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2026
Last Update Date: 01/10/2026
Certification Date: 01/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 STONEWALL RDG
NEWTOWN CT
06470-2454
US

IV. Provider business mailing address

15 STONEWALL RDG
NEWTOWN CT
06470-2454
US

V. Phone/Fax

Practice location:
  • Phone: 203-313-4392
  • Fax:
Mailing address:
  • Phone: 203-313-4392
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: NICOLAS M ORTNER
Title or Position: CEO
Credential:
Phone: 203-313-4392