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General NPI Number Information
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NPI Number | 1134668981
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Entity Type | Organization
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Legal Business Name | COMPLETE NEUROLOGICAL CARE OF NJ PC
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Dates
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Enumeration Date | 02/13/2017
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Last Update Date | 02/13/2017
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Provider Practice Location Address
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Address Line | 124 GREGORY AVE SUITE 203
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City | PASSAIC
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State | NJ
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Zip | 07055-4856
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Country | US
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Telephone | 212-349-2787
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Fax |
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Provider Business Mailing Address
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Address Line | 308 MYERS AVE
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City | HASBROUCK HEIGHTS
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State | NJ
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Zip | 07604-2236
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ELLEN I EDGAR
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Credential | M.D.
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Telephone | 212-349-2787
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0600X
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Taxonomy Name | Clinical Neurophysiology Physician
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License Number | 25MA09993200
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License Number State | NJ
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