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General NPI Number Information
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NPI Number | 1447560677
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Entity Type | Organization
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Legal Business Name | NEUROPSYCHOLOGY AND BRAIN INJURY REHABILITATION SERVICES, PC
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Dates
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Enumeration Date | 10/21/2010
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Last Update Date | 10/21/2010
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Provider Practice Location Address
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Address Line | 2558 WHITNEY AVE
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City | HAMDEN
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State | CT
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Zip | 06518-3046
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Country | US
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Telephone | 203-230-2199
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Fax | 203-230-2242
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Provider Business Mailing Address
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Address Line | 2558 WHITNEY AVE
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City | HAMDEN
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State | CT
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Zip | 06518-3046
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Country | US
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Telephone | 203-230-2199
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Fax | 203-230-2242
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. EUGENE B. PIASETSKY
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Credential | PHD
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Telephone | 203-230-2199
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | 01445
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License Number State | CT
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