Provider Demographics
NPI:1689779894
Name:NEUROSCIENCE INSTITUTE AT ST. FRANCIS MEDICAL CENTER
Entity Type:Organization
Organization Name:NEUROSCIENCE INSTITUTE AT ST. FRANCIS MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:KOLODZIEJ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-599-5320
Mailing Address - Street 1:601 HAMILTON AVE
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08629-1915
Mailing Address - Country:US
Mailing Address - Phone:609-599-5792
Mailing Address - Fax:609-599-6275
Practice Address - Street 1:601 HAMILTON AVE
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08629-1915
Practice Address - Country:US
Practice Address - Phone:609-599-5792
Practice Address - Fax:609-599-6275
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0001538Medicaid
NJ0001538Medicaid