Provider Demographics
NPI:1124395496
Name:NEURORAYS OF NEW JERSEY, P.C.
Entity Type:Organization
Organization Name:NEURORAYS OF NEW JERSEY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:DR
Authorized Official - First Name:NEAL
Authorized Official - Middle Name:M
Authorized Official - Last Name:LISANN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-648-8860
Mailing Address - Street 1:PO BOX 94
Mailing Address - Street 2:
Mailing Address - City:LAKE RONKONKOMA
Mailing Address - State:NY
Mailing Address - Zip Code:11779-0094
Mailing Address - Country:US
Mailing Address - Phone:631-648-8860
Mailing Address - Fax:631-648-8859
Practice Address - Street 1:25 KILMER DR
Practice Address - Street 2:SUITE 104
Practice Address - City:MORGANVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07751-1564
Practice Address - Country:US
Practice Address - Phone:732-851-7449
Practice Address - Fax:732-851-7454
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-30
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty