Healthcare Provider Details

I. General information

NPI: 1578852869
Provider Name (Legal Business Name): NEW YORK NEUROPHYSIOLOGICAL MONITORING SERVICES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2011
Last Update Date: 04/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

76 STARBRUSH CIR
COVINGTON LA
70433
US

IV. Provider business mailing address

76 STARBRUSH CIR
COVINGTON LA
70433
US

V. Phone/Fax

Practice location:
  • Phone: 866-845-4595
  • Fax: 866-845-8810
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL IAN VENGROW
Title or Position: PRESIDNET
Credential: MD
Phone: 866-845-4595