Healthcare Provider Details

I. General information

NPI: 1306437207
Provider Name (Legal Business Name): NEUROSCIENCE RESEARCH INSTITUTE OF FLORIDA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2021
Last Update Date: 02/02/2021
Certification Date: 02/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2010 PONCE DE LEON AVE UNIT F&G
WEST PALM BEACH FL
33407-6040
US

IV. Provider business mailing address

2010 PONCE DE LEON AVE UNIT F&G
WEST PALM BEACH FL
33407-6040
US

V. Phone/Fax

Practice location:
  • Phone: 561-598-6953
  • Fax:
Mailing address:
  • Phone: 561-598-6953
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: DR. DANESH ALAM
Title or Position: CEO
Credential: MD
Phone: 561-678-8600