Healthcare Provider Details

I. General information

NPI: 1275415499
Provider Name (Legal Business Name): AXIONEURO OF NJ LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2025
Last Update Date: 07/21/2025
Certification Date: 07/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 EMMONS ST # 207
LONG BRANCH NJ
07740-6004
US

IV. Provider business mailing address

23 EMMONS ST # 207
LONG BRANCH NJ
07740-6004
US

V. Phone/Fax

Practice location:
  • Phone: 732-996-7999
  • Fax:
Mailing address:
  • Phone: 732-996-7999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0301X
TaxonomyBrain Injury Medicine (Psychiatry & Neurology) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: MOURAD KATTAN
Title or Position: PRESIDENT
Credential:
Phone: 732-996-7999