Provider Demographics
NPI:1780770032
Name:PEDIATRIC NEUROLOGY ASSOCIATES, P.A.
Entity type:Organization
Organization Name:PEDIATRIC NEUROLOGY ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMEIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-993-8777
Mailing Address - Street 1:111 MADISON AVE
Mailing Address - Street 2:SUITE 310
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07960-6097
Mailing Address - Country:US
Mailing Address - Phone:973-993-8777
Mailing Address - Fax:973-993-8577
Practice Address - Street 1:111 MADISON AVE
Practice Address - Street 2:SUITE 310
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-6097
Practice Address - Country:US
Practice Address - Phone:973-993-8777
Practice Address - Fax:973-993-8577
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2998602Medicaid
NJ527807Medicare ID - Type Unspecified