Provider Demographics
NPI:1134906688
Name:CENTER FOR PEDIATRIC NEUROSCIENCE LLC
Entity type:Organization
Organization Name:CENTER FOR PEDIATRIC NEUROSCIENCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, PEDIATRIC NEUROLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:KORNITZER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:862-686-0260
Mailing Address - Street 1:134 BOULEVARD APT 12
Mailing Address - Street 2:
Mailing Address - City:PASSAIC
Mailing Address - State:NJ
Mailing Address - Zip Code:07055-4770
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:134 BOULEVARD APT 12
Practice Address - Street 2:
Practice Address - City:PASSAIC
Practice Address - State:NJ
Practice Address - Zip Code:07055-4770
Practice Address - Country:US
Practice Address - Phone:862-686-0260
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-08
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child NeurologyGroup - Multi-Specialty