Provider Demographics
NPI:1881644102
Name:CLINICAL NEUROPHYSIOLOGY & EPILEPSY P.C.
Entity Type:Organization
Organization Name:CLINICAL NEUROPHYSIOLOGY & EPILEPSY P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LYDIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAJENKO
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:201-943-2273
Mailing Address - Street 1:725 RIVER RD STE 106
Mailing Address - Street 2:
Mailing Address - City:EDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:07020-1170
Mailing Address - Country:US
Mailing Address - Phone:201-943-2273
Mailing Address - Fax:201-215-9548
Practice Address - Street 1:725 RIVER RD STE 106
Practice Address - Street 2:
Practice Address - City:EDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:07020-1170
Practice Address - Country:US
Practice Address - Phone:201-943-2273
Practice Address - Fax:201-215-9548
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-10
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA080617002084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ109294Medicare PIN