| Advanced Neuromed Llc | |
|
1 Degraw Ave Teaneck NJ 07666-4000 | |
| (617) 823-5231 | |
| Not Available |
| Full Name | Advanced Neuromed Llc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 1 Degraw Ave, Teaneck, New Jersey |
| Authorized Official Name and Position | Charlotte Smith (CREDENTAILING) |
| Authorized Official Contact | 3157824207 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Advanced Neuromed Llc 445 Factory St Watertown NY 13601-2729 Ph: (315) 782-4207 | Advanced Neuromed Llc 1 Degraw Ave Teaneck NJ 07666-4000 Ph: (617) 823-5231 |
| NPI Number | 1447878277 |
|---|---|
| Provider Enumeration Date | 07/08/2020 |
| Last Update Date | 07/31/2020 |
| Certification Date | 07/31/2020 |
| Medicare PECOS PAC ID | 4981020385 |
|---|---|
| Medicare Enrollment ID | O20200817001019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1447878277 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | (* (Not Available)) | Primary |
| Provider Name | Charles F Asta |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1245314806 PECOS PAC ID: 5890755482 Enrollment ID: I20041018000990 |
| Provider Name | Farzana Nanavati |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1780629592 PECOS PAC ID: 6800952037 Enrollment ID: I20090312000548 |
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