| Rutgers Health-rwj Pediatric Neurology | |
|
10 Plum St Fl 6 New Brunswick NJ 08901-2066 | |
| (732) 258-7000 | |
| (732) 235-8766 |
| Full Name | Rutgers Health-rwj Pediatric Neurology |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 10 Plum St Fl 6, New Brunswick, New Jersey |
| Authorized Official Name and Position | Brenda Lawrence (DIRECTOR OF REVENUE CYCLE) |
| Authorized Official Contact | 7322356070 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Rutgers Health-rwj Pediatric Neurology 66 W Gilbert St Red Bank NJ 07701 Ph: (732) 212-0051 | Rutgers Health-rwj Pediatric Neurology 10 Plum St Fl 6 New Brunswick NJ 08901-2066 Ph: (732) 258-7000 |
| NPI Number | 1841372224 |
|---|---|
| Provider Enumeration Date | 10/19/2006 |
| Last Update Date | 01/19/2021 |
| Certification Date | 01/19/2021 |
| Medicare PECOS PAC ID | 5698769511 |
|---|---|
| Medicare Enrollment ID | O20040413001373 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1841372224 | NPI | - | NPPES |
| 5290708 | Medicaid | NJ |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0402X | Psychiatry & Neurology - Neurology With Special Qualifications In Child Neurology | (* (Not Available)) | Primary |
| Provider Name | Jan B Wollack |
|---|---|
| Provider Type | Practitioner - Other (physician) |
| Provider Identifiers | NPI Number: 1447345608 PECOS PAC ID: 8628145612 Enrollment ID: I20080917000018 |
| Provider Name | Eveline C Traeger |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1326016304 PECOS PAC ID: 6608935416 Enrollment ID: I20081110000020 |
| Provider Name | Vikram V Bhise |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1700047594 PECOS PAC ID: 7012106123 Enrollment ID: I20110105000420 |
| Provider Name | Emanuel M Dicicco-bloom |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1578658720 PECOS PAC ID: 9537340401 Enrollment ID: I20110224000926 |
| Provider Name | Abdolreza Esfahanizadeh |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1659507275 PECOS PAC ID: 6800078924 Enrollment ID: I20110310001002 |
| Provider Name | Shan Chen |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1184940017 PECOS PAC ID: 5890964803 Enrollment ID: I20110809000355 |
| Provider Name | Manuel Jimenez |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1548427420 PECOS PAC ID: 9537297866 Enrollment ID: I20141204000228 |
| Provider Name | Shauday F Rodney |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356747273 PECOS PAC ID: 9537489364 Enrollment ID: I20150519002131 |
| Provider Name | Anne Morse |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1033499207 PECOS PAC ID: 0042520496 Enrollment ID: I20160420000497 |
| Provider Name | Genevieve Khonghun Gabriel |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1588056758 PECOS PAC ID: 0648543827 Enrollment ID: I20200804002485 |
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