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General NPI Number Information
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NPI Number | 1902583792
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Entity Type | Organization
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Legal Business Name | BRAINWAVES NEURO RESTORATION CENTER, INC.
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Dates
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Enumeration Date | 07/03/2023
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Last Update Date | 07/03/2023
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Provider Practice Location Address
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Address Line | 400 BALD HILL RD
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City | WARWICK
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State | RI
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Zip | 02886-1617
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Country | US
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Telephone | 401-854-7550
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Fax |
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Provider Business Mailing Address
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Address Line | 192 CINDYANN DR
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City | EAST GREENWICH
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State | RI
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Zip | 02818-2428
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | JOSHUA SLEPKOW
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Credential |
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Telephone | 401-854-7550
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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