Basic Information
| Provider Information | |||||||||
| NPI: | 1568707024 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ATLANTIC NEUROLOGY CONSULTING PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 33 OVERLOOK RD | ||||||||
| Address2: | SUITE 401 | ||||||||
| City: | SUMMIT | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 079013570 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2013421205 | ||||||||
| FaxNumber: | 2013421259 | ||||||||
| Practice Location | |||||||||
| Address1: | 33 OVERLOOK RD | ||||||||
| Address2: | SUITE 401 | ||||||||
| City: | SUMMIT | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 079013570 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2013421205 | ||||||||
| FaxNumber: | 2013421259 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/10/2012 | ||||||||
| LastUpdateDate: | 12/10/2012 | ||||||||
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| AuthorizedOfficialLastName: | CRACIUN | ||||||||
| AuthorizedOfficialFirstName: | LIVIU | ||||||||
| AuthorizedOfficialMiddleName: | C | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2012621205 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 25MA08441300 | NJ | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | 148809ZCCM | 01 | NJ | MEDICARE PTAN | OTHER |