Healthcare Provider Details

I. General information

NPI: 1548534993
Provider Name (Legal Business Name): NEW JERSEY PEDIATRIC NEUROLOGICAL ASSOCIATES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2012
Last Update Date: 03/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 MADISON AVE SUITE 140
MORRISTOWN NJ
07960-7360
US

IV. Provider business mailing address

131 MADISON AVE SUITE 140
MORRISTOWN NJ
07960-7360
US

V. Phone/Fax

Practice location:
  • Phone: 973-326-9000
  • Fax: 973-326-9001
Mailing address:
  • Phone: 973-326-9000
  • Fax: 973-326-9001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number25MA06780300
License Number StateNJ

VIII. Authorized Official

Name: DR. CATHERINE A MAZZOLA
Title or Position: PRESIDENT & CEO
Credential: M.D.
Phone: 973-326-9000