Provider Demographics
NPI:1740505619
Name:SAINT CLARE'S HOSPITAL PEDIATRIC NEUROLOGY CLINIC
Entity type:Organization
Organization Name:SAINT CLARE'S HOSPITAL PEDIATRIC NEUROLOGY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, BUDGE REIMBURSEMNT
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEVINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-983-1781
Mailing Address - Street 1:66 FORD ROAD, SUITE 201
Mailing Address - Street 2:SAINT CLARES HOSPITAL
Mailing Address - City:DENVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07834
Mailing Address - Country:US
Mailing Address - Phone:973-983-1751
Mailing Address - Fax:973-983-1779
Practice Address - Street 1:400 WEST BLACKWELL STREET
Practice Address - Street 2:STAINT CLARE'S HOSPITAL PEDIATRIC NEUROLOGY CLINIC
Practice Address - City:DOVER
Practice Address - State:NJ
Practice Address - Zip Code:07801
Practice Address - Country:US
Practice Address - Phone:973-989-3645
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-02
Last Update Date:2010-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center