Healthcare Provider Details

I. General information

NPI: 1992188700
Provider Name (Legal Business Name): ENZO NEUROTECH, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2015
Last Update Date: 10/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9521 B RIVERSIDE PARKWAY #338
TULSA OK
74137-7422
US

IV. Provider business mailing address

PO BOX 700930 #468
TULSA OK
74170-0930
US

V. Phone/Fax

Practice location:
  • Phone: 918-895-7680
  • Fax: 918-236-4646
Mailing address:
  • Phone: 918-895-7680
  • Fax: 918-236-4646

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number
License Number State

VIII. Authorized Official

Name: CRISTI VINSON
Title or Position: BILLING
Credential:
Phone: 918-895-7680