Provider Demographics
NPI:1649351594
Name:GREATER MONMOUTH NEUROLOGY PC
Entity type:Organization
Organization Name:GREATER MONMOUTH NEUROLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SCHUBER
Authorized Official - Middle Name:C
Authorized Official - Last Name:FAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-741-1378
Mailing Address - Street 1:130 MAPLE AVE
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-1734
Mailing Address - Country:US
Mailing Address - Phone:732-741-1378
Mailing Address - Fax:732-741-1677
Practice Address - Street 1:130 MAPLE AVE
Practice Address - Street 2:SUITE 1A
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-1734
Practice Address - Country:US
Practice Address - Phone:732-741-1378
Practice Address - Fax:732-741-1677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2013-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA027734002084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty