Basic Information
| Provider Information | |||||||||
| NPI: | 1104871763 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NEUROLOGICAL MONITORING ASSOCIATES, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 333 W BROWN DEER RD | ||||||||
| Address2: | SUITE 240 | ||||||||
| City: | MILWAUKEE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532172372 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4143516666 | ||||||||
| FaxNumber: | 4143516999 | ||||||||
| Practice Location | |||||||||
| Address1: | 333 W BROWN DEER RD | ||||||||
| Address2: | SUITE 240 | ||||||||
| City: | MILWAUKEE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532172372 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4143516666 | ||||||||
| FaxNumber: | 4143516999 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2006 | ||||||||
| LastUpdateDate: | 02/26/2010 | ||||||||
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| AuthorizedOfficialLastName: | COHEN | ||||||||
| AuthorizedOfficialFirstName: | BERNARD | ||||||||
| AuthorizedOfficialMiddleName: | ALLAN | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4143516666 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | PH.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 246ZE0600X | Y | 193400000X SINGLE SPECIALTY GROUP | Technologists, Technicians & Other Technical Service Providers | Specialist/Technologist, Other | Electroneurodiagnostic |
No ID Information.