Healthcare Provider Details

I. General information

NPI: 1215111240
Provider Name (Legal Business Name): NEUROINTERVENTIONAL ASSOCIATES PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2007
Last Update Date: 05/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

335 31ST ST S
ST PETERSBURG FL
33712-1419
US

IV. Provider business mailing address

335 31ST ST S
ST PETERSBURG FL
33712-1419
US

V. Phone/Fax

Practice location:
  • Phone: 727-289-7139
  • Fax: 727-289-7140
Mailing address:
  • Phone: 727-289-7139
  • Fax: 727-289-7140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: RAZACK NASSER
Title or Position: PRESIDENT
Credential: MD
Phone: 727-289-7139