Organization Name: | LAKESIDE NEUROLOGY & RADIOLOGY OF NEW JERSEY PC |
NPI Number: | 1356537708 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | TOM G WINGER (DIRECTOR) |
Mailing Address: | 1 Gateway Ctr #2600 Newark |
State: | NJ US |
Postal Code: | 071025310 |
Phone Number: | 8475100530 |
Fax Number: | 8883174206 |
NPI Enumeration Date: | 09/19/2007 |
NPI Last Update Date: | 11/12/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | 25MA07746800 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NJ |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |