| Neurodiagnostic Technologies | |
|
1895 Kingsley Ave Suite 1005 Orange Park FL 32073-4466 | |
| (904) 737-5792 | |
| (904) 737-6541 |
| Full Name | Neurodiagnostic Technologies |
|---|---|
| Speciality | Physiological Laboratory |
| Location | 1895 Kingsley Ave, Orange Park, Florida |
| Authorized Official Name and Position | Aurelio A. Muzaurieta (PRESIDENT/TECHNICAL DIRECTOR) |
| Authorized Official Contact | 9047375792 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Neurodiagnostic Technologies Po Box 1450 Orange Park FL 32067-1450 Ph: (904) 737-5792 | Neurodiagnostic Technologies 1895 Kingsley Ave Suite 1005 Orange Park FL 32073-4466 Ph: (904) 737-5792 |
| NPI Number | 1427101658 |
|---|---|
| Provider Enumeration Date | 01/19/2007 |
| Last Update Date | 09/26/2008 |
| Medicare PECOS PAC ID | 9133245319 |
|---|---|
| Medicare Enrollment ID | O20100924000643 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1427101658 | NPI | - | NPPES |
| Provider Name | Amudha M Perumal |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1629003579 PECOS PAC ID: 6103914056 Enrollment ID: I20071112000090 |
| Provider Name | Travis R Von Tobel |
|---|---|
| Provider Type | Practitioner - Pain Management |
| Provider Identifiers | NPI Number: 1487954723 PECOS PAC ID: 3971724477 Enrollment ID: I20150617003007 |
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