Provider Demographics
NPI:1487024162
Name:ARUBAH NEUROSCIENCE INSTITUTE PLLC
Entity type:Organization
Organization Name:ARUBAH NEUROSCIENCE INSTITUTE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:AKRAM
Authorized Official - Middle Name:
Authorized Official - Last Name:SHHADEH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-901-5457
Mailing Address - Street 1:214 GREEN BAY RD
Mailing Address - Street 2:
Mailing Address - City:THIENSVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53092-1616
Mailing Address - Country:US
Mailing Address - Phone:844-458-4201
Mailing Address - Fax:414-247-9004
Practice Address - Street 1:1701 S 23RD ST
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34950-4803
Practice Address - Country:US
Practice Address - Phone:722-448-8600
Practice Address - Fax:722-448-8612
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-07
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL018549200Medicaid