Provider Demographics
NPI:1386003580
Name:EPILEPSY & NEUROPHYSIOLOGY MEDICAL CONSULTANTS, PA
Entity Type:Organization
Organization Name:EPILEPSY & NEUROPHYSIOLOGY MEDICAL CONSULTANTS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHELLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:INFELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-428-3651
Mailing Address - Street 1:690 N BROADWAY
Mailing Address - Street 2:GL1
Mailing Address - City:N WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10603-2417
Mailing Address - Country:US
Mailing Address - Phone:914-428-3651
Mailing Address - Fax:914-428-2648
Practice Address - Street 1:2 CAPITAL WAY
Practice Address - Street 2:3RD FLOOR, SUITE 385
Practice Address - City:PENNINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08534-2521
Practice Address - Country:US
Practice Address - Phone:908-522-4990
Practice Address - Fax:973-538-0043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-16
Last Update Date:2016-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child NeurologyGroup - Multi-Specialty
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical NeurophysiologyGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ461498Medicare PIN