BRAIN MAPPING AND COMPUTERIZED NEUROPHSIOLOGY LABORATORY, INC (NPI# 1720136419) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1720136419 |
| Entity Type | Organization |
| Organization Name | BRAIN MAPPING AND COMPUTERIZED NEUROPHSIOLOGY LABORATORY, INC |
| Practice Address |
1 Randall Sq Suite 409 Providence RI 02904-2709 |
| Practice Telephone | 4012745150 |
| Practice Fax Number | 4012742130 |
| Mailing Telephone | 4012745150 |
| Mailing Fax Number | 4012742130 |
| Enumeration Date | 2007-01-08 |
| Last Update Date | 2012-10-03 |
| Authorized Official Name | DR. JEFFREY M WISHIK (PRESIDENT) |
| Authorized Official Telephone | 4012745150 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 293D00000X | Physiological Laboratory | Laboratories |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| RI | 9000330 | 05 |
| Street Address |
1 RANDALL SQ SUITE 409 |
| City | PROVIDENCE |
| State | RI |
| Zip Code | 02904-2709 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629074752 | Magdalena G Krzystolik | Ophthalmology | 1 Randall Sq, Suite 203, Providence, RI 02904-2709 | 2005-06-23 |
| 1366051849 | Caroline S. Murray | Nurse Practitioner | 1 Randall Sq, Providence, RI 02904-2709 | 2020-07-30 |
| 1134744659 | Briana J. Bartone | Nurse Practitioner | 1 Randall Sq, Providence, RI 02904-2709 | 2020-06-10 |
| 1639717408 | Kaleena Crooks | Registered Nurse | 1 Randall Sq, Providence, RI 02904-2709 | 2019-12-12 |
| 1922657907 | Catherine Putko | Nurse Practitioner | 1 Randall Sq, Providence, RI 02904-2709 | 2019-09-11 |
| 1003383795 | Phina A Mayu | Nurse Practitioner | 1 Randall Sq, Providence, RI 02904-2709 | 2018-10-31 |
| 1982185526 | Takeysha A Duarte | Nurse Practitioner | 1 Randall Sq, Providence, RI 02904-2709 | 2018-08-22 |
| 1184104648 | Bridget M Andaloro | Nurse Practitioner | 1 Randall Sq, Providence, RI 02904-2709 | 2018-08-15 |
| 1649788258 | Caroline Miringu-ruitha | Nurse Practitioner | 1 Randall Sq, Providence, RI 02904-2709 | 2018-01-17 |
| 1083138572 | The Providence Community Health Centers, Inc | Clinic/Center | 1 Randall Sq, Providence, RI 02904-2709 | 2017-07-27 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144792383 | Lifespan Pharmacy LLC | Durable Medical Equipment & Medical Supplies | 180 Corliss Street, Suite A, Providence, RI 02904 | 2018-12-28 |
| 1780168229 | Beth M. Kalunian | Social Worker | 480 Charles Street, Providence, RI 02904 | 2018-09-20 |
| 1588161608 | Michael P. Johnson, Md, Inc | Internal Medicine | 148 W River St Ste 22b, Providence, RI 02904 | 2018-04-06 |
| 1780045948 | Fred Saccoccio | Pharmacist | 15 Smithfield Road, No Providence, RI 02904 | 2016-03-16 |
| 1699148999 | Latin Adult Day Health Care Center | Clinic/Center | 665 Charles Street, Providence, RI 02904 | 2015-11-09 |
| 1144639956 | Dina P Toolin | Occupational Therapist | 195 Collyer St. 3rd Floor, University Medical Center/miriam Hospital Outpatient, Providence, RI 02904 | 2014-08-06 |
| 1801208798 | Seth Clark | Internal Medicine | 200 Corliss St, Providence, RI 02904 | 2014-05-27 |
| 1134554645 | Molly Elizabeth Smith | Physical Therapist | 1405 Douglas Ave, North Providence, RI 02904 | 2013-09-04 |
| 1336408723 | Emad Awa | Pediatrics | 1 Randall Sq Ste 404, Providence, RI 02904 | 2012-05-07 |
| 1598036790 | Joseph F. Osmanski, Od, Inc | Optometrist | 1971 Mineral Spring Avenue, N. Providence, RI 02904 | 2012-01-19 |
| Find all providers in zip 02904 | ||||
| Taxonomy Code | 293D00000X |
| Grouping | Laboratories |
| Classification | Physiological Laboratory |
| A laboratory that operates independently of a hospital and physician’s office to furnish physiological diagnostic services (e.g. EEG’s , EKG’s, scans, etc.). Facilities offering ONLY physiological services are not certified as independent laboratories. If an independent laboratory offers physiological services IN ADDITION to clinical laboratory services, they are surveyed only for compliance with the clinical laboratory regulations because there are no health and safety regulations for physiological services. |
| Notes: Source: Paraphrased from the Medicare Carrier Manual, Section 2070.5. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154452597 | Diagnostic Medical Systems | Physiological Laboratory | 51 Sunset Blvd, Narragansett, RI 02882 | 2007-03-08 |
| 1306096391 | Navix Diagnsotix, Inc. | Physiological Laboratory | 1524 Atwood Ave, Ll2 Ste 244, Johnston, RI 02919-3228 | 2008-09-25 |
| City | PROVIDENCE |
| Zip Code | 02904 |
Please comment or provide details below to improve the information on BRAIN MAPPING AND COMPUTERIZED NEUROPHSIOLOGY LABORATORY, INC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.