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General NPI Number Information
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NPI Number | 1235978115
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Entity Type | Organization
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Legal Business Name | NEXUS NEURODIAGNOSTICS LLC
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Dates
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Enumeration Date | 05/21/2024
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Last Update Date | 05/21/2024
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Provider Practice Location Address
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Address Line | 915 CLINT MOORE RD
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City | BOCA RATON
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State | FL
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Zip | 33487-2802
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Country | US
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Telephone | 405-434-5968
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Fax |
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Provider Business Mailing Address
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Address Line | 915 CLINT MOORE RD
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City | BOCA RATON
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State | FL
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Zip | 33487-2802
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Country | US
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Telephone | 405-434-5968
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | TAYLOR BOSCO
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Credential |
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Telephone | 405-434-5968
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 293D00000X
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Taxonomy Name | Physiological Laboratory
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License Number |
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License Number State |
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