Basic Information
| Provider Information | |||||||||
| NPI: | 1871524066 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HEADACHE & NEUROLOGY CENTER OF NJ, PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 17 TOWER MOUNTAIN DR | ||||||||
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| City: | BERNARDSVILLE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 079241725 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6092615755 | ||||||||
| FaxNumber: | 9086968942 | ||||||||
| Practice Location | |||||||||
| Address1: | 215 UNION AVE | ||||||||
| Address2: | SUITE B | ||||||||
| City: | BRIDGEWATER | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 088073063 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6092615755 | ||||||||
| FaxNumber: | 6092617199 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/05/2006 | ||||||||
| LastUpdateDate: | 03/19/2010 | ||||||||
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| AuthorizedOfficialLastName: | WITTENBORN | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6092615755 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207T00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Neurological Surgery |
No ID Information.