Provider Demographics
NPI:1326394016
Name:CRANIAL REMOLDING CENTER, INC
Entity Type:Organization
Organization Name:CRANIAL REMOLDING CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STUART
Authorized Official - Middle Name:
Authorized Official - Last Name:WEINER
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:732-739-0888
Mailing Address - Street 1:984 HIGHWAY 36
Mailing Address - Street 2:
Mailing Address - City:HAZLET
Mailing Address - State:NJ
Mailing Address - Zip Code:07730-1700
Mailing Address - Country:US
Mailing Address - Phone:732-739-0888
Mailing Address - Fax:732-739-5351
Practice Address - Street 1:984 HIGHWAY 36
Practice Address - Street 2:
Practice Address - City:HAZLET
Practice Address - State:NJ
Practice Address - Zip Code:07730-1700
Practice Address - Country:US
Practice Address - Phone:732-739-0888
Practice Address - Fax:732-739-5351
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-31
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ45P000003300335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier