Provider Demographics
NPI:1538600606
Name:NEUROSHIELD NETWORK SE LLC
Entity type:Organization
Organization Name:NEUROSHIELD NETWORK SE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARCOS
Authorized Official - Middle Name:J
Authorized Official - Last Name:CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-882-3456
Mailing Address - Street 1:PO BOX 75103
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60675-5103
Mailing Address - Country:US
Mailing Address - Phone:973-882-3456
Mailing Address - Fax:973-882-3450
Practice Address - Street 1:700 US HIGHWAY 46
Practice Address - Street 2:SUITE 420
Practice Address - City:FAIRFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07004-1591
Practice Address - Country:US
Practice Address - Phone:973-882-3456
Practice Address - Fax:973-882-3450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-09
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical NeurophysiologyGroup - Single Specialty