Healthcare Provider Details

I. General information

NPI: 1851937981
Provider Name (Legal Business Name): NEURODIAGNOSTICS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/25/2019
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12441 PARKLAWN DR STE 2A
ROCKVILLE MD
20852-2180
US

IV. Provider business mailing address

12441 PARKLAWN DR STE 2A
ROCKVILLE MD
20852-2180
US

V. Phone/Fax

Practice location:
  • Phone: 301-294-7026
  • Fax:
Mailing address:
  • Phone: 301-294-7026
  • Fax: 301-576-8629

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207ZC0500X
TaxonomyCytopathology Physician
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code207ZP0105X
TaxonomyClinical Pathology/Laboratory Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: NICKOLAY KUKEKOV
Title or Position: PRESIDENT
Credential:
Phone: 646-232-8947