Healthcare Provider Details

I. General information

NPI: 1285182618
Provider Name (Legal Business Name): INTERNATIONAL BRAIN RESEARCH FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2016
Last Update Date: 09/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

227 US HIGHWAY 206
FLANDERS NJ
07836-9110
US

IV. Provider business mailing address

227 RTE 206 NORTH
FLANDERS NJ
07836
US

V. Phone/Fax

Practice location:
  • Phone: 732-494-7600
  • Fax:
Mailing address:
  • Phone: 732-494-7600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZE0600X
TaxonomyElectroneurodiagnostic Specialist/Technologist
License Number125903
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2472E0500X
TaxonomyEEG Technician
License Number125903
License Number StateNY

VIII. Authorized Official

Name: MS. LYNNE ESCHER
Title or Position: OFFICE MANAGER
Credential:
Phone: 732-494-7600