Provider Demographics
NPI:1538552799
Name:NEUROTECHNOLOGY, LLC
Entity type:Organization
Organization Name:NEUROTECHNOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NOLAN
Authorized Official - Middle Name:BRUCE
Authorized Official - Last Name:JENEVEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-738-4961
Mailing Address - Street 1:6127 LUTHER LN # 472
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75225-6202
Mailing Address - Country:US
Mailing Address - Phone:214-536-1647
Mailing Address - Fax:214-580-7600
Practice Address - Street 1:6127 LUTHER LN # 472
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75225-6202
Practice Address - Country:US
Practice Address - Phone:214-536-1647
Practice Address - Fax:214-580-7600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-12
Last Update Date:2015-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherGroup - Single Specialty