Provider Demographics
NPI:1457610867
Name:GARDEN STATE NEURO STIMULATION LLC
Entity Type:Organization
Organization Name:GARDEN STATE NEURO STIMULATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SUKDEB
Authorized Official - Middle Name:
Authorized Official - Last Name:DATTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-479-4692
Mailing Address - Street 1:47 WOODLAND AVE
Mailing Address - Street 2:APT 301
Mailing Address - City:SUMMIT
Mailing Address - State:NJ
Mailing Address - Zip Code:07901-2175
Mailing Address - Country:US
Mailing Address - Phone:615-479-4692
Mailing Address - Fax:908-934-9298
Practice Address - Street 1:3657 ALBANY POST RD
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-1177
Practice Address - Country:US
Practice Address - Phone:212-430-0312
Practice Address - Fax:908-934-9298
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-07
Last Update Date:2012-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2590151208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty