Provider Demographics
NPI:1174286819
Name:EPILEPSY INSTITUTE OF NEW JERSEY, INC
Entity Type:Organization
Organization Name:EPILEPSY INSTITUTE OF NEW JERSEY, INC
Other - Org Name:THE EPILEPSY INSTITUTE OF NEW JERSEY, INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANGER
Authorized Official - Prefix:
Authorized Official - First Name:SONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DANIELS
Authorized Official - Suffix:
Authorized Official - Credentials:MBA, MHA
Authorized Official - Phone:718-360-7534
Mailing Address - Street 1:232 PAVONIA AVE # 112
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07302-1739
Mailing Address - Country:US
Mailing Address - Phone:718-360-7534
Mailing Address - Fax:973-718-3282
Practice Address - Street 1:232 PAVONIA AVE # 112
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07302-1739
Practice Address - Country:US
Practice Address - Phone:718-360-7534
Practice Address - Fax:973-718-3282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-19
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Multi-Specialty