Provider Demographics
NPI:1841512951
Name:INTEGRATIVE NEUROLOGY
Entity type:Organization
Organization Name:INTEGRATIVE NEUROLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CRISTIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ENESCU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-557-6330
Mailing Address - Street 1:15 RED HAWK RD N
Mailing Address - Street 2:
Mailing Address - City:COLTS NECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07722-2013
Mailing Address - Country:US
Mailing Address - Phone:732-557-6330
Mailing Address - Fax:732-349-1690
Practice Address - Street 1:3120 54TH ST
Practice Address - Street 2:SUITE L2
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-1530
Practice Address - Country:US
Practice Address - Phone:718-476-5859
Practice Address - Fax:718-476-9859
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-17
Last Update Date:2010-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26MA06969800204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMMGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
029901Medicare PIN