Provider Demographics
NPI:1902142797
Name:NEUROPRACTICE PC
Entity Type:Organization
Organization Name:NEUROPRACTICE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:IRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:KOGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-306-7372
Mailing Address - Street 1:445 KINGS HIGHWAY
Mailing Address - Street 2:2 FLOOR
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-1780
Mailing Address - Country:US
Mailing Address - Phone:718-676-0111
Mailing Address - Fax:718-676-9710
Practice Address - Street 1:3901 HIGHWAY 516
Practice Address - Street 2:SUITE 1C
Practice Address - City:OLD BRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:08857-4900
Practice Address - Country:US
Practice Address - Phone:732-306-7372
Practice Address - Fax:732-707-4101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-24
Last Update Date:2014-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA088000002084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty