Brainwave Neurodiagnostics LLC

Primary specialty

Physiological LaboratoryTaxonomy code 293D00000X

Legal business name

BRAINWAVE NEURODIAGNOSTICS LLC

Practice address

4541 Medical Center Dr
McKinney, TX 75069-1651

Phone

(214) 686-9393

NPI assigned

Jan 8, 2020

Organization subpart

No

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

Authorized official

Name

Nibu MalaickalNPI 1578033254

Title

Owner

Phone

(214) 686-9393

Specialties & licenses 1

Addresses

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Nibu Jacob Malaickal, REEGT, RPSGT,RNCST

  • EEG Specialist/Technologist
  • Coppell, TX
  • NPI 1578033254
  NPD Authorized official
• Rani Thoppil Malaickal, RN

  • Registered Nurse
  • Dallas, TX
  • NPI 1871446427
  NPD

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

{
    "created_epoch": "1578441600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1578441600000",
    "number": "1306486394",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "304 S COPPELL RD",
            "city": "COPPELL",
            "state": "TX",
            "postal_code": "750192417",
            "telephone_number": "214-686-9393"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4541 MEDICAL CENTER DR",
            "city": "MCKINNEY",
            "state": "TX",
            "postal_code": "750691651",
            "telephone_number": "214-686-9393"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRAINWAVE NEURODIAGNOSTICS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-01-08",
        "last_updated": "2020-01-08",
        "certification_date": "2020-01-08",
        "status": "A",
        "authorized_official_last_name": "MALAICKAL",
        "authorized_official_first_name": "NIBU",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "214-686-9393"
    },
    "taxonomies": [
        {
            "code": "293D00000X",
            "taxonomy_group": "",
            "desc": "Physiological Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kailen Elizabeth Bradley, DPT
• Keegan Bradley, MD
• Brady Medical Group PLLC
• Erika Brady, DPT
• Anthony Bragg, DPT
• Aija Brameus
• Emily Katherine Branch, PT, DPT
• Mason Brandon
• Brandy Schumann PHD, PLLC
• Hallie Kate Branner, COTA/L

• Physiological Laboratory in McKinney, TX
• Providers in McKinney, TX by specialty
• Physiological Laboratory in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 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.