Provider Demographics
NPI:1154600302
Name:NEUROLOGY ASSOCIATES OF NORTHERN NJ PC
Entity type:Organization
Organization Name:NEUROLOGY ASSOCIATES OF NORTHERN NJ PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:S
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-322-5124
Mailing Address - Street 1:39 W FRONT ST
Mailing Address - Street 2:
Mailing Address - City:KEYPORT
Mailing Address - State:NJ
Mailing Address - Zip Code:07735-1209
Mailing Address - Country:US
Mailing Address - Phone:732-264-2224
Mailing Address - Fax:
Practice Address - Street 1:39 W FRONT ST
Practice Address - Street 2:
Practice Address - City:KEYPORT
Practice Address - State:NJ
Practice Address - Zip Code:07735-1209
Practice Address - Country:US
Practice Address - Phone:732-264-2224
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-05
Last Update Date:2011-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08576600174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty