Provider Demographics
NPI:1417620113
Name:PRIME NEUROLOGY LLC
Entity Type:Organization
Organization Name:PRIME NEUROLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED AGENT
Authorized Official - Prefix:
Authorized Official - First Name:SWETA
Authorized Official - Middle Name:
Authorized Official - Last Name:GOEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:551-252-5316
Mailing Address - Street 1:120 E MAIN STREET
Mailing Address - Street 2:PMB#199
Mailing Address - City:RAMSEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07446
Mailing Address - Country:US
Mailing Address - Phone:551-252-5316
Mailing Address - Fax:201-849-7545
Practice Address - Street 1:385 PROSPECT AVE STE 208
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-2570
Practice Address - Country:US
Practice Address - Phone:551-252-5316
Practice Address - Fax:201-849-7545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-28
Last Update Date:2021-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty