Provider Demographics
NPI:1578596540
Name:NEUROLOGY PAIN TREATMENT, P.C.
Entity Type:Organization
Organization Name:NEUROLOGY PAIN TREATMENT, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BORIS
Authorized Official - Middle Name:
Authorized Official - Last Name:LEYBEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-797-8333
Mailing Address - Street 1:15 CEDARWOOD LN
Mailing Address - Street 2:
Mailing Address - City:SADDLE RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07458-2604
Mailing Address - Country:US
Mailing Address - Phone:201-797-8333
Mailing Address - Fax:201-791-4877
Practice Address - Street 1:24-20 BROADWAY
Practice Address - Street 2:
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-3057
Practice Address - Country:US
Practice Address - Phone:201-797-8333
Practice Address - Fax:201-791-4877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2008-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA64399174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
G27509Medicare UPIN
NJ102122Medicare PIN