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General NPI Number Information
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NPI Number | 1316467640
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Entity Type | Organization
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Legal Business Name | KIDSNEURO, LLC
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Dates
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Enumeration Date | 06/27/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 205 BROWERTOWN RD STE 1
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City | WOODLAND PARK
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State | NJ
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Zip | 07424-2610
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Country | US
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Telephone | 973-582-0644
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Fax | 973-582-0605
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Provider Business Mailing Address
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Address Line | 205 BROWERTOWN RD #001
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City | WOODLAND PARK
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State | NJ
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Zip | 07424
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Country | US
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Telephone | 973-582-0644
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Fax | 973-582-0605
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Authorized Official
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Title or Position | ATTENDING PHYSICIAN
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Name | DR. JEFFREY KORNITZER
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Credential | MD
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Telephone | 973-582-0644
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0402X
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Taxonomy Name | Neurology with Special Qualifications in Child Neurology Physician
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License Number |
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License Number State |
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