Provider Demographics
NPI:1639464365
Name:CENTRAL NEUROSURGICAL GROUP, P.A.
Entity Type:Organization
Organization Name:CENTRAL NEUROSURGICAL GROUP, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:IRA
Authorized Official - Middle Name:
Authorized Official - Last Name:KASOFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-545-9403
Mailing Address - Street 1:88 HUNTINGTON ST
Mailing Address - Street 2:
Mailing Address - City:NEW BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08901-1003
Mailing Address - Country:US
Mailing Address - Phone:732-545-9403
Mailing Address - Fax:732-545-6224
Practice Address - Street 1:88 HUNTINGTON ST
Practice Address - Street 2:
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901-1003
Practice Address - Country:US
Practice Address - Phone:732-545-9403
Practice Address - Fax:732-545-6224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-10
Last Update Date:2011-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03335600207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0405001Medicaid
NJ603571Medicare PIN
NJ0405001Medicaid