Provider Demographics
NPI:1669527073
Name:NEUROSURGICAL CARE OF NEW JERSEY, P.A.
Entity type:Organization
Organization Name:NEUROSURGICAL CARE OF NEW JERSEY, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RODERICK
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:CLEMENTE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-744-3166
Mailing Address - Street 1:96 GATES AVE
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-2511
Mailing Address - Country:US
Mailing Address - Phone:973-744-3166
Mailing Address - Fax:973-744-3199
Practice Address - Street 1:96 GATES AVE
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-2511
Practice Address - Country:US
Practice Address - Phone:973-744-3166
Practice Address - Fax:973-744-3199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2013-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04150100207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJC59724Medicare UPIN