Provider Demographics
NPI:1386444065
Name:MOUNTAINSIDE NEUROPSYCHOLOGY, LLC
Entity type:Organization
Organization Name:MOUNTAINSIDE NEUROPSYCHOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANJULI
Authorized Official - Middle Name:
Authorized Official - Last Name:BODAPATI
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:908-913-0462
Mailing Address - Street 1:306 WOODS END RD
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07090-2908
Mailing Address - Country:US
Mailing Address - Phone:845-797-8390
Mailing Address - Fax:
Practice Address - Street 1:608 SHERWOOD PKWY STE 2D
Practice Address - Street 2:
Practice Address - City:MOUNTAINSIDE
Practice Address - State:NJ
Practice Address - Zip Code:07092-2512
Practice Address - Country:US
Practice Address - Phone:908-913-0462
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-13
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty