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General NPI Number Information
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NPI Number | 1013271840
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Entity Type | Organization
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Legal Business Name | NEUROLOGIA DIAGNOSTICS LLC
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Dates
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Enumeration Date | 06/26/2012
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Last Update Date | 06/26/2012
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Provider Practice Location Address
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Address Line | 2575 UNIVERSITY AVE W SUITE 100
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City | SAINT PAUL
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State | MN
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Zip | 55114-1073
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Country | US
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Telephone | 651-641-1770
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Fax | 651-641-1773
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Provider Business Mailing Address
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Address Line | 2575 UNIVERSITY AVE W SUITE 100
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City | SAINT PAUL
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State | MN
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Zip | 55114-1073
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Country | US
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Telephone | 651-641-1770
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Fax | 651-641-1773
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | DR. AYDIN MORADIAN
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Credential |
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Telephone | 651-641-2836
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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