MEDICARE: NATIONAL NEURODIAGNOSTIC TECHNOLOGIES INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084N0600X	Clinical Neurophysiology Physician
2	231H00000X	Audiologist
3	2471V0105X	Vascular Sonography Radiologic Technologist
4	246ZE0600X	Electroneurodiagnostic Specialist/Technologist
5	293D00000X	Physiological Laboratory	HCC4403	FL

General Provider Information

NPI Number	:	1427101658
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NATIONAL NEURODIAGNOSTIC TECHNOLOGIES INC

Provider Business Mailing Address
First Line	:	PO BOX 1450
Second Line	:
City	:	ORANGE PARK
State	:	FL
Zip	:	32067-1450
Country	:	US
Telephone Number	:	904-737-5792
Fax Number	:	904-737-6541

Provider Business Practice Location Address
First Line	:	1895 KINGSLEY AVE
Second Line	:	SUITE 1005
City	:	ORANGE PARK
State	:	FL
Zip	:	32073-4466
Country	:	US
Telephone Number	:	904-737-5792
Fax Number	:	904-737-6541

Authorized Official
Title or Position	:	PRESIDENT/TECHNICAL DIRECTOR
Name	:	MR. AURELIO A. MUZAURIETA JR.
Credential	:	B.A.,RVT, R NCS T
Telephone Number	:	904-737-5792

Provider Enumeration Date	:	01/19/2007
Last Update Date	:	09/26/2008

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