Provider Demographics
NPI:1821017260
Name:GARDEN STATE NEUROLOGY AND NEURO-ONCOLOGY, PC
Entity Type:Organization
Organization Name:GARDEN STATE NEUROLOGY AND NEURO-ONCOLOGY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SUMUL
Authorized Official - Middle Name:N
Authorized Official - Last Name:RAVAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-229-6200
Mailing Address - Street 1:PO BOX 190
Mailing Address - Street 2:
Mailing Address - City:EATONTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07724-0190
Mailing Address - Country:US
Mailing Address - Phone:732-229-6200
Mailing Address - Fax:732-229-6201
Practice Address - Street 1:100 STATE HWY 36 EAST
Practice Address - Street 2:SUITE 2P (2ND FLOOR)
Practice Address - City:WEST LONG BRANCH
Practice Address - State:NJ
Practice Address - Zip Code:07764
Practice Address - Country:US
Practice Address - Phone:732-229-6200
Practice Address - Fax:732-229-6201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA071837002084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ097722Medicare ID - Type UnspecifiedGROUP MEDICARE NUMBER