Provider Demographics
NPI:1497466858
Name:EDISON NEUROLOGY LLC
Entity Type:Organization
Organization Name:EDISON NEUROLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HASMUKH
Authorized Official - Middle Name:
Authorized Official - Last Name:SUTARIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:908-672-0403
Mailing Address - Street 1:17 ANNA LN
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-1503
Mailing Address - Country:US
Mailing Address - Phone:908-672-0403
Mailing Address - Fax:908-756-6879
Practice Address - Street 1:CAREWELL HEALTH MEDICAL CENTER
Practice Address - Street 2:300 CENTRAL AVENUE
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07018
Practice Address - Country:US
Practice Address - Phone:973-672-8400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-07
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1568750263Medicaid
NJ1366408056Medicaid