Provider Demographics
NPI:1780827162
Name:NEUROPHYSIOLOGIC INTERPRETIVE SPECIALISTS LLC
Entity Type:Organization
Organization Name:NEUROPHYSIOLOGIC INTERPRETIVE SPECIALISTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARCOS
Authorized Official - Middle Name:J
Authorized Official - Last Name:CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-882-3456
Mailing Address - Street 1:700 US HIGHWAY 46
Mailing Address - Street 2:SUITE 420
Mailing Address - City:FAIRFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07004-1591
Mailing Address - Country:US
Mailing Address - Phone:973-882-3456
Mailing Address - Fax:973-882-3450
Practice Address - Street 1:700 US HIGHWAY 46
Practice Address - Street 2:SUITE 420
Practice Address - City:FAIRFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07004-1591
Practice Address - Country:US
Practice Address - Phone:973-882-3456
Practice Address - Fax:973-882-3450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-14
Last Update Date:2015-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ217989Medicare PIN