Healthcare Provider Details

I. General information

NPI: 1740865799
Provider Name (Legal Business Name): PHMD NEURO MONITORING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2021
Last Update Date: 03/11/2021
Certification Date: 03/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1084 MAIN AVE
CLIFTON NJ
07011-2330
US

IV. Provider business mailing address

1084 MAIN AVE
CLIFTON NJ
07011-2330
US

V. Phone/Fax

Practice location:
  • Phone: 914-376-6100
  • Fax:
Mailing address:
  • Phone: 914-376-6100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number
License Number State

VIII. Authorized Official

Name: MARVELL SCOTT
Title or Position: OWNER
Credential: MD
Phone: 914-376-6100