Basic Information
| Provider Information | |||||||||
| NPI: | 1194013276 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | INTEGRAL NEUROLOGIC AND SLEEP MEDICINE CONSULTANTS LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 633 RTE 37 W | ||||||||
| Address2: | |||||||||
| City: | TOMS RIVER | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 087558007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7322404787 | ||||||||
| FaxNumber: | 7325751597 | ||||||||
| Practice Location | |||||||||
| Address1: | 633 RTE 37 W | ||||||||
| Address2: | |||||||||
| City: | TOMS RIVER | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 087558007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7322404787 | ||||||||
| FaxNumber: | 7325751597 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/11/2011 | ||||||||
| LastUpdateDate: | 07/26/2011 | ||||||||
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| AuthorizedOfficialLastName: | ROSANIO | ||||||||
| AuthorizedOfficialFirstName: | YVONNE | ||||||||
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| AuthorizedOfficialTitleorPosition: | BILLING MGR | ||||||||
| AuthorizedOfficialTelephone: | 7322404787 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0400X | MA39406 | NJ | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
No ID Information.