| Name: | Brain Mapping and Computerized Neurophsiology Laboratory, Inc. |
| Jurisdiction: | Rhode Island |
| Entity type: | Domestic Profit Corporation |
| Status: | Activ |
| Date of Organization in Rhode Island: | 05 Jul 1989 (36 years ago) |
| Identification Number: | 000056596 |
| ZIP code: | 02904 |
| County: | Providence County |
| Principal Address: | 1 RANDALL SQUARE SUITE 409, PROVIDENCE, RI, 02904, USA |
| Purpose: | PRACTICE OF MEDICINE |
| NAICS: | 621511 - Medical Laboratories |
| Fictitious names: |
ADHD Center of New England (trading name, 2009-12-01 - ) |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1720136419 | 2007-01-08 | 2012-10-03 | 1 RANDALL SQ, SUITE 409, PROVIDENCE, RI, 029042709, US | 1 RANDALL SQ, SUITE 409, PROVIDENCE, RI, 029042709, US | |||||||||||||||||||||
|
|||||||||||||||||||||||||
| Phone | +1 401-274-5150 |
| Fax | 4012742130 |
Authorized person
| Name | DR. JEFFREY M WISHIK |
| Role | PRESIDENT |
| Phone | 4012745150 |
Taxonomy
| Taxonomy Code | 293D00000X - Physiological Laboratory |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 9000330 |
| State | RI |
| Name | Role | Address |
|---|---|---|
| DAVID N. BAZAR, ESQ. | Agent | 197 TAUNTON AVENUE SUITE 202, EAST PROVIDENCE, RI, 02914, USA |
| Name | Role | Address |
|---|---|---|
| JEFFREY WISHIK M.D. | TREASURER | ONE RANDALL SQUARE, SUITE 409 PROVIDENCE, RI 02904 USA |
| Name | Role | Address |
|---|---|---|
| DAVID N. BAZAR ESQ. | SECRETARY | 197 TAUNTON AVENUE EAST PROVIDENCE, RI 02914 USA |
| Name | Role | Address |
|---|---|---|
| JEFFREY WISHIK MD | PRESIDENT | ONE RANDALL SQUARE, SUITE 409 PROVIDENCE, RI 02904 USA |
| Name | Role | Address |
|---|---|---|
| JEFFREY WISHIK M.D. | DIRECTOR | ONE RANDALL SQUARE, SUITE 409 PROVIDENCE, RI 02904 USA |
| Number | Name | File Date |
|---|---|---|
| 202448666020 | Annual Report | 2024-03-15 |
| 202329866020 | Annual Report | 2023-03-03 |
| 202212653090 | Annual Report | 2022-03-11 |
| 202187503110 | Annual Report | 2021-01-21 |
| 202036062650 | Statement of Change of Registered/Resident Agent | 2020-03-09 |
| 202035168290 | Annual Report | 2020-02-24 |
| 201987090110 | Annual Report | 2019-02-19 |
| 201856238810 | Annual Report | 2018-01-16 |
| 201730756920 | Annual Report | 2017-01-23 |
| 201691016530 | Annual Report | 2016-01-19 |
Date of last update: 07 Oct 2024
Sources: Rhode Island Department of State
