Provider Demographics
NPI:1922587062
Name:PRINCETON NEUROLOGICAL INSTITUTE LLC
Entity Type:Organization
Organization Name:PRINCETON NEUROLOGICAL INSTITUTE LLC
Other - Org Name:UNITED MEDICAL MONITORING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:GREMILLION
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-404-7717
Mailing Address - Street 1:50 ROSE PL
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-5312
Mailing Address - Country:US
Mailing Address - Phone:888-279-6336
Mailing Address - Fax:888-289-5601
Practice Address - Street 1:50 ROSE PL
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11040-5312
Practice Address - Country:US
Practice Address - Phone:888-279-6336
Practice Address - Fax:888-289-5601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-09
Last Update Date:2018-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ246ZE0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnosticGroup - Single Specialty