Provider Demographics
NPI:1730738386
Name:FOJ NEURO DIAGNOSTICS LLC
Entity type:Organization
Organization Name:FOJ NEURO DIAGNOSTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:844-212-5321
Mailing Address - Street 1:PO BOX 6529
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75071-5114
Mailing Address - Country:US
Mailing Address - Phone:844-212-5321
Mailing Address - Fax:214-279-6348
Practice Address - Street 1:13421 TANGLERIDGE LN
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75240-5342
Practice Address - Country:US
Practice Address - Phone:844-212-5321
Practice Address - Fax:214-279-6348
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-06
Last Update Date:2019-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory