Provider Demographics
NPI:1558503672
Name:NEW JERSEY PEDIATRIC NEUROSCIENCE INSTITUTE, LLC
Entity Type:Organization
Organization Name:NEW JERSEY PEDIATRIC NEUROSCIENCE INSTITUTE, LLC
Other - Org Name:NJPNI
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:MAZZOLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-326-9000
Mailing Address - Street 1:131 MADISON AVE
Mailing Address - Street 2:SUITE 140
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07960-7360
Mailing Address - Country:US
Mailing Address - Phone:973-326-9000
Mailing Address - Fax:973-326-9001
Practice Address - Street 1:131 MADISON AVE
Practice Address - Street 2:SUITE 140
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-7360
Practice Address - Country:US
Practice Address - Phone:973-326-9000
Practice Address - Fax:973-326-9001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-03
Last Update Date:2013-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA06484600207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ156528Medicare UPIN