=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225172851
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NEUROTECH INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/16/2007
-----------------------------------------------------
Last Update Date | 04/24/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 125 PARKER HILL AVE SUITE 300
-----------------------------------------------------
City | BOSTON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02120-2847
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-731-0016
-----------------------------------------------------
Fax | 617-739-6866
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 125 PARKER HILL AVE SUITE 300
-----------------------------------------------------
City | BOSTON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02120-2847
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-731-0016
-----------------------------------------------------
Fax | 617-739-6866
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DEEPAK S TANDON
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 617-731-0016
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084N0400X
-----------------------------------------------------
Taxonomy Name | Neurology Physician
-----------------------------------------------------
License Number | 46565
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------