Provider Demographics
NPI:1568707024
Name:ATLANTIC NEUROLOGY CONSULTING PC
Entity Type:Organization
Organization Name:ATLANTIC NEUROLOGY CONSULTING PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LIVIU
Authorized Official - Middle Name:C
Authorized Official - Last Name:CRACIUN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-262-1205
Mailing Address - Street 1:33 OVERLOOK RD
Mailing Address - Street 2:SUITE 401
Mailing Address - City:SUMMIT
Mailing Address - State:NJ
Mailing Address - Zip Code:07901-3570
Mailing Address - Country:US
Mailing Address - Phone:201-342-1205
Mailing Address - Fax:201-342-1259
Practice Address - Street 1:33 OVERLOOK RD
Practice Address - Street 2:SUITE 401
Practice Address - City:SUMMIT
Practice Address - State:NJ
Practice Address - Zip Code:07901-3570
Practice Address - Country:US
Practice Address - Phone:201-342-1205
Practice Address - Fax:201-342-1259
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-10
Last Update Date:2012-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08441300174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ148809ZCCMOtherMEDICARE PTAN