Provider Demographics
NPI:1851794903
Name:GNI NEUROSERVICES LLC
Entity Type:Organization
Organization Name:GNI NEUROSERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT, ADMINISTRATION
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:J
Authorized Official - Last Name:DAMICO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-962-9600
Mailing Address - Street 1:1 MEDICAL CENTER BLVD STE 232
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19013-3902
Mailing Address - Country:US
Mailing Address - Phone:844-464-6387
Mailing Address - Fax:215-239-3037
Practice Address - Street 1:3100 PRINCETON PIKE BLDG 3
Practice Address - Street 2:SUITE D
Practice Address - City:LAWRENCEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08648-2300
Practice Address - Country:US
Practice Address - Phone:844-464-6387
Practice Address - Fax:215-239-3037
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-03
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PADV8240OtherPA RAILROAD MEDICARE
NJDV8143OtherNJ RAILROAD MEDICARE
NJ0467669Medicaid
PA103013426Medicaid
PA103013426Medicaid
PA413035Medicare PIN