Provider Demographics
NPI:1265432595
Name:THE NEUROSCIENCE CENTER OF NORTHERN NEW JERSEY , PA
Entity type:Organization
Organization Name:THE NEUROSCIENCE CENTER OF NORTHERN NEW JERSEY , PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:DIAMOND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-285-1446
Mailing Address - Street 1:310 MADISON AVE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07960-6909
Mailing Address - Country:US
Mailing Address - Phone:973-285-1446
Mailing Address - Fax:973-605-8854
Practice Address - Street 1:310 MADISON AVE
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-6909
Practice Address - Country:US
Practice Address - Phone:973-285-1446
Practice Address - Fax:973-605-8854
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GACC8184OtherRR MEDICARE
NJ6967205Medicaid
GACC8184OtherRR MEDICARE