Provider Demographics
NPI:1194904714
Name:HEADACHE & NEUROLOGICAL CARE CENTER OF NEW JERSEY
Entity type:Organization
Organization Name:HEADACHE & NEUROLOGICAL CARE CENTER OF NEW JERSEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MONTE
Authorized Official - Middle Name:B
Authorized Official - Last Name:PELLMAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-431-4323
Mailing Address - Street 1:2 PARAGON WAY
Mailing Address - Street 2:SUITE 400
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-7897
Mailing Address - Country:US
Mailing Address - Phone:732-431-4323
Mailing Address - Fax:732-431-4435
Practice Address - Street 1:2 PARAGON WAY
Practice Address - Street 2:SUITE 400
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-7897
Practice Address - Country:US
Practice Address - Phone:732-431-4323
Practice Address - Fax:732-431-4435
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-31
Last Update Date:2009-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA031393002084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ087583Medicare PIN