Healthcare Provider Details

I. General information

NPI: 1790165462
Provider Name (Legal Business Name): NEW NEURONS NEUROSURGICAL INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2015
Last Update Date: 06/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32 SUMMIT AVE
CHATHAM NJ
07928
US

IV. Provider business mailing address

32 SUMMIT AVE
CHATHAM NJ
07928-2733
US

V. Phone/Fax

Practice location:
  • Phone: 973-718-3360
  • Fax:
Mailing address:
  • Phone: 973-718-3360
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2086S0120X
TaxonomyPediatric Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. SONNIE DANIELS
Title or Position: CHIEF OPERATING OFFICER
Credential: MBA
Phone: 973-718-3360