Healthcare Provider Details

I. General information

NPI: 1467755066
Provider Name (Legal Business Name): INNOVATIVE NEUROPHYSIOLOGY ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2010
Last Update Date: 07/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1716 NEW HAVEN ROAD
BARDSTOWN KY
40004
US

IV. Provider business mailing address

1716 NEW HAVEN RD
BARDSTOWN KY
40004-2311
US

V. Phone/Fax

Practice location:
  • Phone: 502-996-1578
  • Fax:
Mailing address:
  • Phone: 502-999-6776
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. MANOJ PATEL
Title or Position: CEO/OWNER
Credential:
Phone: 502-099-6776