Provider Demographics
NPI:1255574794
Name:RIVERFRONT NEUROLOGICAL ASSOC LLC
Entity type:Organization
Organization Name:RIVERFRONT NEUROLOGICAL ASSOC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:YANNETTE
Authorized Official - Suffix:
Authorized Official - Credentials:CMRS
Authorized Official - Phone:201-837-7003
Mailing Address - Street 1:725 RIVER RD
Mailing Address - Street 2:STE 106
Mailing Address - City:EDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:07020-1171
Mailing Address - Country:US
Mailing Address - Phone:201-943-2273
Mailing Address - Fax:201-215-9548
Practice Address - Street 1:725 RIVER RD
Practice Address - Street 2:STE 106
Practice Address - City:EDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:07020-1171
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:2009-04-14
Last Update Date:2009-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08061700207T00000X
NJ25MA081135002084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
No207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ=========OtherEIN NUMBER