Provider Demographics
NPI:1548534993
Name:NEW JERSEY PEDIATRIC NEUROLOGICAL ASSOCIATES, PC
Entity type:Organization
Organization Name:NEW JERSEY PEDIATRIC NEUROLOGICAL ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:A
Authorized Official - Last Name:MAZZOLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-326-9000
Mailing Address - Street 1:131 MADISON AVE
Mailing Address - Street 2:SUITE 140
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07960-7360
Mailing Address - Country:US
Mailing Address - Phone:973-326-9000
Mailing Address - Fax:973-326-9001
Practice Address - Street 1:131 MADISON AVE
Practice Address - Street 2:SUITE 140
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-7360
Practice Address - Country:US
Practice Address - Phone:973-326-9000
Practice Address - Fax:973-326-9001
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEW JERSEY PEDIATRIC NEUROSURGICAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-03-02
Last Update Date:2012-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA067803002084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child NeurologyGroup - Single Specialty