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General NPI Number Information
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NPI Number | 1710499132
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Entity Type | Organization
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Legal Business Name | ILIAD NEUROSCIENCES INC.
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Dates
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Enumeration Date | 10/25/2017
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Last Update Date | 10/25/2017
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Provider Practice Location Address
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Address Line | 5110 CAMPUS DR STE 190
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City | PLYMOUTH MEETING
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State | PA
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Zip | 19462-1143
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Country | US
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Telephone | 610-441-9050
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Fax |
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Provider Business Mailing Address
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Address Line | 5110 CAMPUS DR STE 190
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City | PLYMOUTH MEETING
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State | PA
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Zip | 19462-1143
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Country | US
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Telephone | 610-441-9050
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING MANAGER
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Name | BRYNN MARTINEZ
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Credential |
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Telephone | 832-434-8523
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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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