| Neuroshield Network Se Llc | |
|
700 Us Highway 46 Suite 420 Fairfield NJ 07004-1591 | |
| (973) 882-3456 | |
| (973) 882-3450 |
| Full Name | Neuroshield Network Se Llc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 700 Us Highway 46, Fairfield, New Jersey |
| Authorized Official Name and Position | Marcos J Cruz (OWNER) |
| Authorized Official Contact | 9738823456 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Neuroshield Network Se Llc Po Box 5805 Carol Stream IL 60197-5805 Ph: (973) 882-3456 | Neuroshield Network Se Llc 700 Us Highway 46 Suite 420 Fairfield NJ 07004-1591 Ph: (973) 882-3456 |
| NPI Number | 1538600606 |
|---|---|
| Provider Enumeration Date | 03/09/2017 |
| Last Update Date | 03/09/2017 |
| Medicare PECOS PAC ID | 7719243492 |
|---|---|
| Medicare Enrollment ID | O20171113003482 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1538600606 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0600X | Psychiatry & Neurology - Clinical Neurophysiology | (* (Not Available)) | Primary |
| Provider Name | Marcos Cruz |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1265556898 PECOS PAC ID: 3870652472 Enrollment ID: I20171120000609 |
| Provider Name | Lori Ilyse Gerber |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1235393109 PECOS PAC ID: 2163560103 Enrollment ID: I20180124001994 |
| Provider Name | Steven Daniel Factor |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1730472408 PECOS PAC ID: 8325327703 Enrollment ID: I20180808002225 |
| Provider Name | Sarah Zubkov |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1215262720 PECOS PAC ID: 0749596567 Enrollment ID: I20181204002292 |
| Provider Name | Steven Urbaniak |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1891774634 PECOS PAC ID: 5395827299 Enrollment ID: I20190823000023 |
| Provider Name | Ruby Reid |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1700128287 PECOS PAC ID: 5890086417 Enrollment ID: I20200125000344 |
| Provider Name | Seth David Scholl |
|---|---|
| Provider Type | Practitioner - Osteopathic Manipulative Medicine |
| Provider Identifiers | NPI Number: 1245262922 PECOS PAC ID: 3577507151 Enrollment ID: I20200406002720 |
| Provider Name | Breyanna Grays |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1942560800 PECOS PAC ID: 3274825641 Enrollment ID: I20211026003032 |
| Provider Name | Thai Son Dang |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1023514122 PECOS PAC ID: 0648667030 Enrollment ID: I20231117001138 |
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