Provider Demographics
NPI:1407157803
Name:ADVANCE NEURO
Entity Type:Organization
Organization Name:ADVANCE NEURO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NEUROLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CRISTIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ENESCU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-557-6330
Mailing Address - Street 1:15 RED HAWK RD N
Mailing Address - Street 2:
Mailing Address - City:COLTS NECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07722-2013
Mailing Address - Country:US
Mailing Address - Phone:732-557-6330
Mailing Address - Fax:732-349-1690
Practice Address - Street 1:20 HOSPITAL DR STE 9
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-6434
Practice Address - Country:US
Practice Address - Phone:732-557-6330
Practice Address - Fax:732-349-1690
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-16
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA069698002084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty