| Name: | Brain Mapping and Computerized Neurophsiology Laboratory, Inc. |
| Jurisdiction: | Rhode Island |
| Entity type: | Domestic Profit Corporation |
| Status: | Dissolved |
| Date of Organization in Rhode Island: | 05 Jul 1989 (36 years ago) |
| Date of Dissolution: | 03 Jan 2025 (3 months ago) |
| Date of Status Change: | 03 Jan 2025 (3 months 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 |
| Fictitious names: |
ADHD Center of New England (trading name, 2009-12-01 - ) |
NAICS
621511 Medical LaboratoriesThis U.S. industry comprises establishments known as medical laboratories primarily engaged in providing analytic or diagnostic services, including body fluid analysis, generally to the medical profession or to the patient on referral from a health practitioner. Learn more at the U.S. Census Bureau
| 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 Apr 2025
Sources: Rhode Island Department of State
