Healthcare Provider Details

I. General information

NPI: 1912820614
Provider Name (Legal Business Name): MINDSPAN MEDICAL AMERICA PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2026
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

169 MADISON AVE STE 90030
NEW YORK NY
10016-5101
US

IV. Provider business mailing address

169 MADISON AVE STE 90030
NEW YORK NY
10016-5101
US

V. Phone/Fax

Practice location:
  • Phone: 508-494-8275
  • Fax:
Mailing address:
  • Phone: 508-494-8275
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State

VIII. Authorized Official

Name: CARLOS RODRIGUEZ
Title or Position: GENERAL COUNSEL
Credential:
Phone: 787-923-1393