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General NPI Number Information
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NPI Number | 1003625294
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Entity Type | Organization
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Legal Business Name | PRONEURODIAGNOSTICS
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Dates
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Enumeration Date | 01/02/2025
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Last Update Date | 01/02/2025
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Provider Practice Location Address
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Address Line | 37 NORTHERN BLVD UNIT 366
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City | GREENVALE
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State | NY
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Zip | 11548-4015
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Country | US
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Telephone | 516-353-1735
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Fax |
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Provider Business Mailing Address
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Address Line | 37 NORTHERN BLVD UNIT 366
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City | GREENVALE
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State | NY
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Zip | 11548-4015
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Country | US
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Telephone | 516-353-1735
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. ALI RODRIGUEZ
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Credential |
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Telephone | 516-353-1735
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084D0003X
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Taxonomy Name | Diagnostic Neuroimaging (Psychiatry & Neurology) Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 246ZE0500X
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Taxonomy Name | EEG Specialist/Technologist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 246ZE0600X
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Taxonomy Name | Electroneurodiagnostic Specialist/Technologist
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 204R00000X
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Taxonomy Name | Electrodiagnostic Medicine Physician
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License Number |
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License Number State |
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