Healthcare Provider Details

I. General information

NPI: 1902742265
Provider Name (Legal Business Name): MY NEUROLOGIST, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2026
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 ELM AVE 3RD FLOOR
HACKENSACK NJ
07601
US

IV. Provider business mailing address

17 ELM AVE 3RD FLOOR
HACKENSACK NJ
07601
US

V. Phone/Fax

Practice location:
  • Phone: 551-236-3190
  • Fax:
Mailing address:
  • Phone: 551-236-3190
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. OLGA NOSKIN
Title or Position: MANAGING MEMBER
Credential: MD
Phone: 551-236-3190