Provider Demographics
NPI:1245912450
Name:NEUROSCIENCE INSTITUTE FOR TRAUMA INC
Entity type:Organization
Organization Name:NEUROSCIENCE INSTITUTE FOR TRAUMA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:908-224-5161
Mailing Address - Street 1:1 CRESTVIEW CT E
Mailing Address - Street 2:
Mailing Address - City:MORRIS PLAINS
Mailing Address - State:NJ
Mailing Address - Zip Code:07950-2003
Mailing Address - Country:US
Mailing Address - Phone:201-407-0921
Mailing Address - Fax:
Practice Address - Street 1:777 PASSAIC AVE STE 565
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07012-1874
Practice Address - Country:US
Practice Address - Phone:908-224-5161
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-07
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty