Basic Information
| Provider Information | |||||||||
| NPI: | 1730628280 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SYNERGY NEUROMONITORING TECHNICAL, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 550 N CENTRAL EXPY UNIT 2586 | ||||||||
| Address2: | |||||||||
| City: | MCKINNEY | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750700139 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037044621 | ||||||||
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| Practice Location | |||||||||
| Address1: | 925B PEACHTREE ST NE | ||||||||
| Address2: | SUITE 710 | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 30309 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037044621 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/16/2017 | ||||||||
| LastUpdateDate: | 10/05/2020 | ||||||||
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| AuthorizedOfficialLastName: | SMOLENYAK | ||||||||
| AuthorizedOfficialFirstName: | NICOLE | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRACTICE ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 3037044621 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 09/30/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 246ZE0500X | N | 193200000X MULTI-SPECIALTY GROUP | Technologists, Technicians & Other Technical Service Providers | Specialist/Technologist, Other | EEG | 246ZE0600X | Y | 193200000X MULTI-SPECIALTY GROUP | Technologists, Technicians & Other Technical Service Providers | Specialist/Technologist, Other | Electroneurodiagnostic |
No ID Information.