Neuronorwell Inc.

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

NEURONORWELL INC.

Doing business as

NeuroSport

Practice address

15 Linden Ave
Salem, MA 01970-4249

Phone

(508) 212-2074

NPI assigned

Aug 24, 2020

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Fred Willis

Title

President & Ceo

Phone

(508) 212-2074

Specialties & licenses 1

Addresses

Other names 1

• NeuroSport Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1598227200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598227200000",
    "number": "1093328791",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15 LINDEN AVE",
            "city": "SALEM",
            "state": "MA",
            "postal_code": "019704249",
            "telephone_number": "508-212-2074"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15 LINDEN AVE",
            "city": "SALEM",
            "state": "MA",
            "postal_code": "019704249",
            "telephone_number": "508-212-2074"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEURONORWELL INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-08-24",
        "last_updated": "2020-08-24",
        "certification_date": "2020-08-24",
        "status": "A",
        "authorized_official_last_name": "WILLIS",
        "authorized_official_first_name": "FRED",
        "authorized_official_title_or_position": "PRESIDENT & CEO",
        "authorized_official_telephone_number": "508-212-2074",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "NeuroSport",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Courtney Neff, MD
• Jessica Neffinger
• Romy Nehme, M.D.
• Kimberly Diane Nelson
• Robert R Nersasian, DMD
• Peter K Newman, PA-C
• Jahvon Amieke Newton
• Julie Nguyen
• Tan Minh Nguyen
• Niki Nikolouzos

• Clinic/Center in Salem, MA
• Providers in Salem, MA by specialty
• Clinic/Center in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.