Provider Demographics
NPI:1871995092
Name:NEURO CONNECT CORP.
Entity type:Organization
Organization Name:NEURO CONNECT CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MISS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:LEA
Authorized Official - Last Name:RUSSO
Authorized Official - Suffix:
Authorized Official - Credentials:R EEG T
Authorized Official - Phone:808-754-7967
Mailing Address - Street 1:1188 BISHOP ST
Mailing Address - Street 2:SUITE # 607
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-3302
Mailing Address - Country:US
Mailing Address - Phone:888-541-5509
Mailing Address - Fax:808-356-0771
Practice Address - Street 1:1188 BISHOP ST
Practice Address - Street 2:SUITE # 607
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-3302
Practice Address - Country:US
Practice Address - Phone:888-541-5509
Practice Address - Fax:808-356-0771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-18
Last Update Date:2014-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory