Provider Demographics
NPI:1114064144
Name:GENERAL NEUROLOGY AND HEADACHE DISORDERS, P.A.
Entity Type:Organization
Organization Name:GENERAL NEUROLOGY AND HEADACHE DISORDERS, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARINA
Authorized Official - Middle Name:
Authorized Official - Last Name:SOBOL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-767-1500
Mailing Address - Street 1:2 LINCOLN HWY
Mailing Address - Street 2:SUITE 509
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-3961
Mailing Address - Country:US
Mailing Address - Phone:732-767-1500
Mailing Address - Fax:732-767-0090
Practice Address - Street 1:2 LINCOLN HWY
Practice Address - Street 2:SUITE 509
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-3961
Practice Address - Country:US
Practice Address - Phone:732-767-1500
Practice Address - Fax:732-767-0090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0042099Medicaid
NJ058313Medicare PIN