MEDICARE: NEUROREEF LABS 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	171W00000X	Contractor

General Provider Information

NPI Number	:	1477317154
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEUROREEF LABS INC

Provider Business Mailing Address
First Line	:	5406 MIDDLE FISKVILLE RD APT 250
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78751-1416
Country	:	US
Telephone Number	:	512-712-8409
Fax Number	:

Provider Business Practice Location Address
First Line	:	5406 MIDDLE FISKVILLE RD APT 250
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78751-1416
Country	:	US
Telephone Number	:	512-712-8409
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DR. SATWANT KUMAR
Credential	:	MBBS, PHD
Telephone Number	:	512-712-8409

Provider Enumeration Date	:	02/12/2024
Last Update Date	:	02/13/2024

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