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General NPI Number Information
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NPI Number | 1861995094
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Entity Type | Organization
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Legal Business Name | NEURO-DIAGNOSTIC ENTERPRISE
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Dates
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Enumeration Date | 03/14/2018
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Last Update Date | 11/17/2022
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Provider Practice Location Address
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Address Line | 2800 BISCAYNE BLVD STE 1000B
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City | MIAMI
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State | FL
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Zip | 33137-4559
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Country | US
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Telephone | 786-886-8608
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Fax | 305-675-4601
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Provider Business Mailing Address
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Address Line | 14241 SW 129TH CT
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City | MIAMI
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State | FL
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Zip | 33186-8903
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Country | US
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Telephone | 305-951-9332
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Fax |
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Authorized Official
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Title or Position | NEURODIAGNOSTIC TECHNOLOGIST
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Name | MR. CRISTOBAL P CORREDOR
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Credential | R.NCS.T,EEG.T,EP.T
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Telephone | 305-951-9332
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 204R00000X
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Taxonomy Name | Electrodiagnostic Medicine Physician
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License Number |
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License Number State |
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