Provider Demographics
NPI:1942401153
Name:NEW JERSEY NEUROSCIENCE ASSOCIATES
Entity Type:Organization
Organization Name:NEW JERSEY NEUROSCIENCE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NEUROPSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:DORFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:201-845-0055
Mailing Address - Street 1:114 ESSEX ST FL 3
Mailing Address - Street 2:
Mailing Address - City:ROCHELLE PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07662-4335
Mailing Address - Country:US
Mailing Address - Phone:201-845-0055
Mailing Address - Fax:
Practice Address - Street 1:114 ESSEX ST FL 3
Practice Address - Street 2:
Practice Address - City:ROCHELLE PARK
Practice Address - State:NJ
Practice Address - Zip Code:07662-4335
Practice Address - Country:US
Practice Address - Phone:201-845-0055
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty