Provider Demographics
NPI:1033314133
Name:THE NEW JERSEY INSTITUTE OF NEUROBEHAVIOR, LLC
Entity Type:Organization
Organization Name:THE NEW JERSEY INSTITUTE OF NEUROBEHAVIOR, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CLINICAL SERVICES
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:BRAGONIER
Authorized Official - Last Name:GILLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:908-604-1100
Mailing Address - Street 1:665 MARTINSVILLE RD
Mailing Address - Street 2:RIVERWALK VILLAGE CENTER, SUITE 218
Mailing Address - City:BASKING RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07920-4700
Mailing Address - Country:US
Mailing Address - Phone:908-604-1100
Mailing Address - Fax:908-607-1866
Practice Address - Street 1:665 MARTINSVILLE RD
Practice Address - Street 2:RIVERWALK VILLAGE CENTER, SUITE 218
Practice Address - City:BASKING RIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07920-4700
Practice Address - Country:US
Practice Address - Phone:908-604-1100
Practice Address - Fax:908-607-1866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1838103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty