MEDICARE: NJ NEUROLOGY INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM2500X	Medical Specialty Clinic/Center

General Provider Information

NPI Number	:	1770762197
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NJ NEUROLOGY INC.

Provider Business Mailing Address
First Line	:	114 ESSEX ST FL 3
Second Line	:
City	:	ROCHELLE PARK
State	:	NJ
Zip	:	07662-4335
Country	:	US
Telephone Number	:	201-845-0055
Fax Number	:	201-845-0068

Provider Business Practice Location Address
First Line	:	114 ESSEX ST FL 3
Second Line	:
City	:	ROCHELLE PARK
State	:	NJ
Zip	:	07662-4335
Country	:	US
Telephone Number	:	201-845-0055
Fax Number	:	201-845-0068

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ROMANA KULIKOVA
Credential	:	M.D.
Telephone Number	:	201-845-0055

Provider Enumeration Date	:	11/01/2007
Last Update Date	:	11/01/2007

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