Healthcare Provider Details

I. General information

NPI: 1962849935
Provider Name (Legal Business Name): GUARDIAN INTRAOPERATIVE NEUROMOMITORING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2013
Last Update Date: 05/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

576 VALLEY BROOK AVE
LYNDHURST NJ
07071
US

IV. Provider business mailing address

576 VALLEY BROOK AVE
LYNDHURST NJ
07071-1919
US

V. Phone/Fax

Practice location:
  • Phone: 201-933-5450
  • Fax: 201-933-5452
Mailing address:
  • Phone: 201-933-5450
  • Fax: 201-933-5452

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberMC050084
License Number StateNJ

VIII. Authorized Official

Name: DR. DAVID G HARRIS
Title or Position: OWNER
Credential: DC
Phone: 201-933-5450