Provider Demographics
NPI:1871524066
Name:HEADACHE & NEUROLOGY CENTER OF NJ, PA
Entity type:Organization
Organization Name:HEADACHE & NEUROLOGY CENTER OF NJ, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:WITTENBORN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-261-5755
Mailing Address - Street 1:17 TOWER MOUNTAIN DR
Mailing Address - Street 2:
Mailing Address - City:BERNARDSVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07924-1725
Mailing Address - Country:US
Mailing Address - Phone:609-261-5755
Mailing Address - Fax:908-696-8942
Practice Address - Street 1:215 UNION AVE
Practice Address - Street 2:SUITE B
Practice Address - City:BRIDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:08807-3063
Practice Address - Country:US
Practice Address - Phone:609-261-5755
Practice Address - Fax:609-261-7199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2010-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ035201Medicare ID - Type Unspecified