NPIMap

Organization Active NPI

Neuro DX Services LLC

  • Electrodiagnostic Medicine Physician
  • Fort Myers, FL
National Provider Identifier
1649504515
Registry record updated Jun 14, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Electrodiagnostic Medicine PhysicianTaxonomy code 204R00000X
License
OS7123 Issued in FL
Legal business name
NEURO DX SERVICES LLC
Practice address
8801 College Pkwy
Suite 2
Fort Myers, FL 33919-4882
Phone
(239) 482-0300
Fax
(239) 482-4757
NPI assigned
Sep 25, 2009
Last updated
Jun 14, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 14, 2012

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

Authorized official

Name
George S Petryk, DC,DACNB,FACFN,FABESNPI 1477551430
Title
President
Phone
(239) 482-0300

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology ChiropractorGroup: 193200000X MULTI-SPECIALTY GROUP 111NN0400X CH8431 FL
Electrodiagnostic Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 204R00000X OS7123 FL Primary
General Practice PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208D00000X OS7123 FL
Physiological Laboratory 293D00000X FL

Addresses

Primary practice location

8801 College Pkwy
Suite 2
Fort Myers, FL 33919-4882

Mailing address

15880 Summerlin Rd Ste 300
PMB 106
Fort Myers, FL 33908-9613
Phone (239) 482-0300

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1253836800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1339632000000",
    "number": "1649504515",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15880 SUMMERLIN RD STE 300",
            "address_2": "PMB 106",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339089613",
            "telephone_number": "239-482-0300",
            "fax_number": "239-482-4757"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8801 COLLEGE PKWY",
            "address_2": "SUITE 2",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339194882",
            "telephone_number": "239-482-0300",
            "fax_number": "239-482-4757"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEURO DX SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-09-25",
        "last_updated": "2012-06-14",
        "status": "A",
        "authorized_official_last_name": "PETRYK",
        "authorized_official_first_name": "GEORGE",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "239-482-0300",
        "authorized_official_credential": "DC,DACNB,FACFN,FABES"
    },
    "taxonomies": [
        {
            "code": "111NN0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor, Neurology",
            "state": "FL",
            "license": "CH8431",
            "primary": false
        },
        {
            "code": "204R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Electrodiagnostic Medicine",
            "state": "FL",
            "license": "OS7123",
            "primary": true
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": "FL",
            "license": "OS7123",
            "primary": false
        },
        {
            "code": "293D00000X",
            "taxonomy_group": "",
            "desc": "Physiological Laboratory",
            "state": "FL",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Myers, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2012; 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.