1528366911 NPI number — THE NEUROLOGY AND HEADACHE CENTER OF NEW JERSEY LLC

Table of content: (NPI 1528366911)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528366911 NPI number — THE NEUROLOGY AND HEADACHE CENTER OF NEW JERSEY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE NEUROLOGY AND HEADACHE CENTER OF NEW JERSEY LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1528366911
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/09/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
573 CRANBURY RD
Provider Second Line Business Mailing Address:
SUITE A5
Provider Business Mailing Address City Name:
EAST BRUNSWICK
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08816-4144
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-254-5101
Provider Business Mailing Address Fax Number:
732-254-2640

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
573 CRANBURY RD
Provider Second Line Business Practice Location Address:
SUITE A5
Provider Business Practice Location Address City Name:
EAST BRUNSWICK
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08816-4144
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-254-5101
Provider Business Practice Location Address Fax Number:
732-254-2640
Provider Enumeration Date:
03/09/2011

Additional Information

Authorized Official

Authorized Official Last Name:
LAZAR
Authorized Official First Name:
MARK
Authorized Official Middle Name:
H
Authorized Official Title or Position:
PHYSICIAN OWNER
Authorized Official Telephone Number:
732-254-5101

Provider Taxonomy Codes

  • Taxonomy code: 2084N0400X , with the licence number:  42290 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com