Organization
ADVANCED NEURODIAGNOSTIC CENTER, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SIMIN MIRTAHERI (PRESIDENT)
(504) 885-3737
Entity
Organization
Contact information
Practice address
2905 KINGMAN ST, METAIRIE, LA 70006-6615
(504) 885-3737
(504) 885-5507
Mailing address
2905 KINGMAN ST FL 2, METAIRIE, LA 70006-6615
(504) 885-3737
(504) 885-5507
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
—
LA
2084P0800X
Psychiatry Physician
—
LA
2084P2900X
Pain Medicine (Psychiatry & Neurology) Physician
201074
LA
2084S0012X
Sleep Medicine (Psychiatry & Neurology) Physician
—
LA
2085R0202X
Diagnostic Radiology Physician
—
LA
363L00000X
Nurse Practitioner
AP06242
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1946613
—
LA
01
—
435707150C
BCBS
LA
01
—
4391937610
BCBS
LA
01
—
548670743D
BLUE CROSS
LA
01
—
767164775A
BCBS
LA
Enumeration date
01/08/2007
Last updated
10/11/2011
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