Provider Demographics
NPI:1053351536
Name:NEURAL WATCH LLC
Entity type:Organization
Organization Name:NEURAL WATCH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MGR
Authorized Official - Prefix:MS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:WESCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-213-3931
Mailing Address - Street 1:812 AVIS DR
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48108-9649
Mailing Address - Country:US
Mailing Address - Phone:734-213-3931
Mailing Address - Fax:866-634-2766
Practice Address - Street 1:812 AVIS DR
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48108-9649
Practice Address - Country:US
Practice Address - Phone:734-213-3931
Practice Address - Fax:866-634-2766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-06
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDS103650Medicare PIN
NJ168935Medicare PIN
FLAB499Medicare PIN
MI0P22900Medicare PIN
OH9377641Medicare PIN
TX0A6013Medicare PIN
KSKA2913Medicare PIN
ILIL4920Medicare PIN