Organization
BRAIN MAPPING AND COMPUTERIZED NEUROPHSIOLOGY LABORATORY, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JEFFREY M WISHIK MD (PRESIDENT)
(401) 274-5150
Entity
Organization
Contact information
Practice address
1 RANDALL SQ, SUITE 409, PROVIDENCE, RI 02904-2709
(401) 274-5150
(401) 274-2130
Mailing address
1 RANDALL SQ, SUITE 409, PROVIDENCE, RI 02904-2709
(401) 274-5150
(401) 274-2130
Taxonomy
Speciality
Code
Description
License number
State
293D00000X
Physiological Laboratory
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9000330
—
RI
Enumeration date
01/08/2007
Last updated
10/03/2012
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