Provider Demographics
NPI:1316467640
Name:KIDSNEURO, LLC
Entity type:Organization
Organization Name:KIDSNEURO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ATTENDING PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:KORNITZER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-582-0644
Mailing Address - Street 1:205 BROWERTOWN RD
Mailing Address - Street 2:#001
Mailing Address - City:WOODLAND PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07424
Mailing Address - Country:US
Mailing Address - Phone:973-582-0644
Mailing Address - Fax:973-582-0605
Practice Address - Street 1:205 BROWERTOWN RD STE 1
Practice Address - Street 2:
Practice Address - City:WOODLAND PARK
Practice Address - State:NJ
Practice Address - Zip Code:07424-2610
Practice Address - Country:US
Practice Address - Phone:973-582-0644
Practice Address - Fax:973-582-0605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child NeurologyGroup - Single Specialty