Provider Demographics
NPI:1528366911
Name:THE NEUROLOGY AND HEADACHE CENTER OF NEW JERSEY LLC
Entity Type:Organization
Organization Name:THE NEUROLOGY AND HEADACHE CENTER OF NEW JERSEY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:H
Authorized Official - Last Name:LAZAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-254-5101
Mailing Address - Street 1:573 CRANBURY RD
Mailing Address - Street 2:SUITE A5
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-4144
Mailing Address - Country:US
Mailing Address - Phone:732-254-5101
Mailing Address - Fax:732-254-2640
Practice Address - Street 1:573 CRANBURY RD
Practice Address - Street 2:SUITE A5
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-4144
Practice Address - Country:US
Practice Address - Phone:732-254-5101
Practice Address - Fax:732-254-2640
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-09
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ422902084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJE13111Medicare UPIN