Provider Demographics
NPI:1336469105
Name:NEURO DIAGNOSTIC ASSOCIATES LLC
Entity Type:Organization
Organization Name:NEURO DIAGNOSTIC ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHWARTZ
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:866-943-8682
Mailing Address - Street 1:18945 CONCERTO DR
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33498-4870
Mailing Address - Country:US
Mailing Address - Phone:866-943-8682
Mailing Address - Fax:561-470-0339
Practice Address - Street 1:1 BRIDGE PLZ N
Practice Address - Street 2:STE 275
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-7101
Practice Address - Country:US
Practice Address - Phone:866-943-8682
Practice Address - Fax:561-470-0339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-03
Last Update Date:2010-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB06381000207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty