Organization
NEURO SOURCE DIAGNOSTICS, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RYAN ROSSIEN (OWNER)
(215) 460-7475
Entity
Organization
Contact information
Practice address
9276 JAMISON AVE, UNIT A, PHILADELPHIA, PA 19115-4281
(215) 460-7475
(215) 677-2073
Mailing address
9276 JAMISON AVE, UNIT A, PHILADELPHIA, PA 19115-4281
(215) 460-7475
(215) 677-2073
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Enumeration date
03/24/2014
Last updated
03/25/2014
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