1922388008 NPI number — BRAIN INSTITUTE OF NORTHERN NEW JERSEY PA

Table of content: (NPI 1922388008)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922388008 NPI number — BRAIN INSTITUTE OF NORTHERN NEW JERSEY PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BRAIN INSTITUTE OF NORTHERN NEW JERSEY PA
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:
1922388008
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
725 RIVER RD
Provider Second Line Business Mailing Address:
SUITE 106
Provider Business Mailing Address City Name:
EDGEWATER
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07020-1171
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
646-712-1635
Provider Business Mailing Address Fax Number:
866-267-8173

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8 S MORRIS ST
Provider Second Line Business Practice Location Address:
SUITE 302
Provider Business Practice Location Address City Name:
DOVER
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07801-4649
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
646-712-1635
Provider Business Practice Location Address Fax Number:
866-267-8173
Provider Enumeration Date:
08/22/2011

Additional Information

Authorized Official

Authorized Official Last Name:
SHAJENKO
Authorized Official First Name:
LYDIA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
646-712-1635

Provider Taxonomy Codes

  • Taxonomy code: 261QM1300X , with the licence number:  25MA08061700 , 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