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General NPI Number Information
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NPI Number | 1124395496
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Entity Type | Organization
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Legal Business Name | NEURORAYS OF NEW JERSEY, P.C.
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Dates
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Enumeration Date | 11/30/2011
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Last Update Date | 11/30/2011
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Provider Practice Location Address
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Address Line | 25 KILMER DR SUITE 104
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City | MORGANVILLE
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State | NJ
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Zip | 07751-1564
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Country | US
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Telephone | 732-851-7449
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Fax | 732-851-7454
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Provider Business Mailing Address
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Address Line | PO BOX 94
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City | LAKE RONKONKOMA
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State | NY
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Zip | 11779-0094
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Country | US
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Telephone | 631-648-8860
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Fax | 631-648-8859
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Authorized Official
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Title or Position | M.D.
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Name | DR. NEAL M. LISANN
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Credential | M.D.
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Telephone | 631-648-8860
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State | NJ
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