Healthcare Provider Details

I. General information

NPI: 1013998830
Provider Name (Legal Business Name): EPILEPSY & NEUROPHYSIOLOGY MEDICAL CONSULTANTS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2005
Last Update Date: 03/04/2022
Certification Date: 03/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 PROSPECT AVE SUITE 800
HACKENSACK NJ
07601-1997
US

IV. Provider business mailing address

333 WESTCHESTER AVE STE E104
WHITE PLAINS NY
10604-2930
US

V. Phone/Fax

Practice location:
  • Phone: 201-996-3205
  • Fax: 201-343-6689
Mailing address:
  • Phone: 914-428-3651
  • Fax: 914-428-2948

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MARCELO E LANCMAN
Title or Position: OWNER
Credential: MD
Phone: 914-428-3651