Provider Demographics
NPI:1861995094
Name:NEURO-DIAGNOSTIC ENTERPRISE
Entity type:Organization
Organization Name:NEURO-DIAGNOSTIC ENTERPRISE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NEURODIAGNOSTIC TECHNOLOGIST
Authorized Official - Prefix:MR
Authorized Official - First Name:CRISTOBAL
Authorized Official - Middle Name:P
Authorized Official - Last Name:CORREDOR
Authorized Official - Suffix:
Authorized Official - Credentials:RNCST,EEGT,EPT
Authorized Official - Phone:305-951-9332
Mailing Address - Street 1:14241 SW 129TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-8903
Mailing Address - Country:US
Mailing Address - Phone:305-951-9332
Mailing Address - Fax:
Practice Address - Street 1:2800 BISCAYNE BLVD STE 1000B
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33137-4559
Practice Address - Country:US
Practice Address - Phone:786-886-8608
Practice Address - Fax:305-675-4601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-14
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204R00000XAllopathic & Osteopathic PhysiciansElectrodiagnostic MedicineGroup - Single Specialty