Healthcare Provider Details

I. General information

NPI: 1083169122
Provider Name (Legal Business Name): NEUROEDGE MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2016
Last Update Date: 01/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 W FAIRBANKS AVE # 180
WINTER PARK FL
32789
US

IV. Provider business mailing address

127 W FAIRBANKS AVE # 180
WINTER PARK FL
32789-4326
US

V. Phone/Fax

Practice location:
  • Phone: 877-479-4004
  • Fax: 407-440-1820
Mailing address:
  • Phone: 877-479-4004
  • Fax: 407-440-1820

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZE0600X
TaxonomyElectroneurodiagnostic Specialist/Technologist
License Number
License Number StateFL

VIII. Authorized Official

Name: CARLOS RAMOS
Title or Position: MANAGER
Credential:
Phone: 877-479-4004