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General NPI Number Information
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NPI Number | 1508273327
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Entity Type | Organization
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Legal Business Name | HACKENSACK EPILEPSY CENTER PC
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Dates
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Enumeration Date | 07/14/2014
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Last Update Date | 07/14/2014
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Provider Practice Location Address
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Address Line | 260 OLD HOOK RD SUITE 200
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City | WESTWOOD
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State | NJ
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Zip | 07675-3123
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Country | US
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Telephone | 201-546-8509
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Fax | 201-503-8142
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Provider Business Mailing Address
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Address Line | PO BOX 1447
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City | ENGLEWOOD CLIFFS
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State | NJ
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Zip | 07632-0447
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Country | US
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Telephone | 201-967-8425
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Fax | 201-263-4665
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Authorized Official
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Title or Position | M.D.
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Name | GEORGES GHACIBEH
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Credential | M.D.
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Telephone | 201-546-8509
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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 | 25MA08232000
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 2084S0012X
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Taxonomy Name | Sleep Medicine (Psychiatry & Neurology) Physician
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License Number | 25MA08232000
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License Number State | NJ
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Taxonomy #3
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 25MA08232000
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License Number State | NJ
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