Healthcare Provider Details

I. General information

NPI: 1598547960
Provider Name (Legal Business Name): NEUROSYNC MEDICAL GROUP (NJ), P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2023
Last Update Date: 10/19/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 WASHINGTON ST
HOLLISTON MA
01746
US

IV. Provider business mailing address

118 WASHINGTON ST
HOLLISTON MA
01746
US

V. Phone/Fax

Practice location:
  • Phone: 855-455-4500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code2081P0301X
TaxonomyBrain Injury Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. GARY GREGORY
Title or Position: SECRETARY
Credential:
Phone: 508-397-8885