Provider Demographics
NPI:1598063588
Name:GARDEN STATE NEURO STIMULATION LLC
Entity type:Organization
Organization Name:GARDEN STATE NEURO STIMULATION LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHANCE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCELHANEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-261-3602
Mailing Address - Street 1:10740 N CENTRAL EXPY
Mailing Address - Street 2:SUITE 275
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-2161
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:111 WANAQUE AVE
Practice Address - Street 2:
Practice Address - City:POMPTON LAKES
Practice Address - State:NJ
Practice Address - Zip Code:07442-2101
Practice Address - Country:US
Practice Address - Phone:214-261-3602
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-01
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty