Basic Information
| Provider Information | |||||||||
| NPI: | 1780827162 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NEUROPHYSIOLOGIC INTERPRETIVE SPECIALISTS LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 700 US HIGHWAY 46 | ||||||||
| Address2: | SUITE 420 | ||||||||
| City: | FAIRFIELD | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070041591 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9738823456 | ||||||||
| FaxNumber: | 9738823450 | ||||||||
| Practice Location | |||||||||
| Address1: | 700 US HIGHWAY 46 | ||||||||
| Address2: | SUITE 420 | ||||||||
| City: | FAIRFIELD | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070041591 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9738823456 | ||||||||
| FaxNumber: | 9738823450 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/14/2009 | ||||||||
| LastUpdateDate: | 04/22/2015 | ||||||||
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| AuthorizedOfficialLastName: | CRUZ | ||||||||
| AuthorizedOfficialFirstName: | MARCOS | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER/PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 9738823456 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0400X | NJ | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
No ID Information.