Organization Active NPI

Neurodiagnostics LTD.

  • Neurology Physician
  • Farmington, NM
National Provider Identifier
1942365416
Registry record updated Dec 21, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
License
2000-14 Issued in NM
Legal business name
NEURODIAGNOSTICS LTD.
Practice address
4801 N Butler Ave
Ste. 8102
Farmington, NM 87401-0818
Phone
(505) 326-7153
Fax
(505) 326-7767
NPI assigned
Dec 26, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 21, 2007

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

Authorized official

Name
Denise Breeden
Title
Office Manager
Phone
(505) 326-7153

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2084N0400X 2000-14 NM Primary

Addresses

Primary practice location

4801 N Butler Ave
Ste. 8102
Farmington, NM 87401-0818

Mailing address

4801 N Butler Ave
Ste. 8102
Farmington, NM 87401-0818
Phone (505) 326-7153

Other identifiers 1

IdentifierTypeStateIssuer
69631MedicaidNM

National Provider Directory

National Provider Directory

Locations

4800 College Blvd
Ste 102
Farmington, NM 87402
Phone (505) 326-1753

4801 N Butler Ave
Ste 8102
Farmington, NM 87401
Phone (505) 326-7153

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1167091200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1198195200000",
    "number": "1942365416",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4801 N BUTLER AVE",
            "address_2": "STE. 8102",
            "city": "FARMINGTON",
            "state": "NM",
            "postal_code": "874010818",
            "telephone_number": "505-326-7153",
            "fax_number": "505-326-7767"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4801 N BUTLER AVE",
            "address_2": "STE. 8102",
            "city": "FARMINGTON",
            "state": "NM",
            "postal_code": "874010818",
            "telephone_number": "505-326-7153",
            "fax_number": "505-326-7767"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEURODIAGNOSTICS LTD.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-26",
        "last_updated": "2007-12-21",
        "status": "A",
        "authorized_official_last_name": "BREEDEN",
        "authorized_official_first_name": "DENISE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "505-326-7153"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "NM",
            "license": "2000-14",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "69631",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Farmington, NM

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2007; 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.