Provider Demographics
NPI:1568553287
Name:ATLANTIC NEUROSURGICAL SPECIALISTS PA
Entity Type:Organization
Organization Name:ATLANTIC NEUROSURGICAL SPECIALISTS PA
Other - Org Name:ATLANTIC NEUROSURGICAL SPECIALISTS
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:MARY ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:GOMEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-285-7800
Mailing Address - Street 1:310 MADISON AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07960
Mailing Address - Country:US
Mailing Address - Phone:973-285-7800
Mailing Address - Fax:973-285-7839
Practice Address - Street 1:310 MADISON AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960
Practice Address - Country:US
Practice Address - Phone:973-285-7800
Practice Address - Fax:973-285-7839
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ434141Medicare PIN