Provider Demographics
NPI:1942718929
Name:BEACON NEURODIAGNOSTIC ASSOCIATES LLC.
Entity Type:Organization
Organization Name:BEACON NEURODIAGNOSTIC ASSOCIATES LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:UZMA
Authorized Official - Middle Name:
Authorized Official - Last Name:KAZMI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-923-9949
Mailing Address - Street 1:106 E MOORE ST
Mailing Address - Street 2:
Mailing Address - City:HACKETTSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07840-2026
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:106 E MOORE ST
Practice Address - Street 2:
Practice Address - City:HACKETTSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07840-2026
Practice Address - Country:US
Practice Address - Phone:347-996-4398
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-12
Last Update Date:2018-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty