MEDICARE: COGENT NEURODIAGNOSTICS LLC

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	246ZE0600X	Electroneurodiagnostic Specialist/Technologist

General Provider Information

NPI Number	:	1902103245
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COGENT NEURODIAGNOSTICS LLC

Provider Business Mailing Address
First Line	:	7655 S GOOSEBERRY WAY
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85747-5341
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7655 S GOOSEBERRY WAY
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85747-5341
Country	:	US
Telephone Number	:	520-261-3757
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. JUSTIN M DEARDORFF
Credential	:	CNIM
Telephone Number	:	520-261-3757

Provider Enumeration Date	:	02/23/2011
Last Update Date	:	02/23/2011

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