Healthcare Provider Details

I. General information

NPI: 1780770032
Provider Name (Legal Business Name): PEDIATRIC NEUROLOGY ASSOCIATES, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 MADISON AVE SUITE 310
MORRISTOWN NJ
07960-6097
US

IV. Provider business mailing address

111 MADISON AVE SUITE 310
MORRISTOWN NJ
07960-6097
US

V. Phone/Fax

Practice location:
  • Phone: 973-993-8777
  • Fax: 973-993-8577
Mailing address:
  • Phone: 973-993-8777
  • Fax: 973-993-8577

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: MRS. DONNA HAMEIER
Title or Position: OFFICE MANAGER
Credential:
Phone: 973-993-8777