Provider Demographics
NPI:1235978115
Name:NEXUS NEURODIAGNOSTICS LLC
Entity type:Organization
Organization Name:NEXUS NEURODIAGNOSTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:TAYLOR
Authorized Official - Middle Name:
Authorized Official - Last Name:BOSCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-434-5968
Mailing Address - Street 1:915 CLINT MOORE RD
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33487-2802
Mailing Address - Country:US
Mailing Address - Phone:405-434-5968
Mailing Address - Fax:
Practice Address - Street 1:915 CLINT MOORE RD
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33487-2802
Practice Address - Country:US
Practice Address - Phone:405-434-5968
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-21
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory