Provider Demographics
NPI:1619168564
Name:NEURO-ONCOLOGY ASSOCIATES,PC
Entity Type:Organization
Organization Name:NEURO-ONCOLOGY ASSOCIATES,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSCIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:GRUBER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-270-7828
Mailing Address - Street 1:BRAIN TUMOR CENTER AT OVERLOOK HOSPITAL
Mailing Address - Street 2:99 BEAUVOIR AVENUE
Mailing Address - City:SUMMIT
Mailing Address - State:NJ
Mailing Address - Zip Code:07901
Mailing Address - Country:US
Mailing Address - Phone:908-522-5914
Mailing Address - Fax:908-522-5845
Practice Address - Street 1:BRAIN TUMOR CENTER AT OVERLOOK HOSPITAL
Practice Address - Street 2:99 BEAUVOIR AVENUE
Practice Address - City:SUMMIT
Practice Address - State:NJ
Practice Address - Zip Code:07901
Practice Address - Country:US
Practice Address - Phone:908-522-5914
Practice Address - Fax:908-522-5845
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-06
Last Update Date:2007-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA025010261QX0200X
NY098755261QX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0200XAmbulatory Health Care FacilitiesClinic/CenterOncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJC58562Medicare UPIN
NJ127259A9PMedicare Oscar/Certification