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General NPI Number Information
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NPI Number | 1982143913
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Entity Type | Organization
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Legal Business Name | INGENIUM NEUROPSYCHOLOGY LLC
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Dates
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Enumeration Date | 02/23/2017
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Last Update Date | 02/25/2017
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Provider Practice Location Address
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Address Line | 51 CHESTNUT ST SUITE 4
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City | RIDGEWOOD
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State | NJ
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Zip | 07450-3873
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Country | US
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Telephone | 617-895-8970
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Fax |
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Provider Business Mailing Address
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Address Line | 51 CHESTNUT ST SUITE 4
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City | RIDGEWOOD
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State | NJ
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Zip | 07450-3873
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Country | US
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Telephone | 617-895-8970
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Fax |
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Authorized Official
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Title or Position | CLINICAL NEUROPSYCHOLOGIST
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Name | DR. JOANNA MARIE SALMON
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Credential | PHD, MBA
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Telephone | 617-895-8970
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | 35SI00498300
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License Number State | NJ
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