Provider Demographics
NPI:1598199838
Name:NEUROLOGIC SPECIALTIES, LLC
Entity Type:Organization
Organization Name:NEUROLOGIC SPECIALTIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:I
Authorized Official - Last Name:MARQUINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-488-1515
Mailing Address - Street 1:211 ESSEX ST STE 202
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-3245
Mailing Address - Country:US
Mailing Address - Phone:201-488-1515
Mailing Address - Fax:201-488-9471
Practice Address - Street 1:211 ESSEX ST STE 202
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-3245
Practice Address - Country:US
Practice Address - Phone:201-488-1515
Practice Address - Fax:201-488-9471
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-22
Last Update Date:2013-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA067502002084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty