Provider Demographics
NPI:1053557066
Name:GARDEN STATE NEURO DIAGNOSTIC LABS, INC.
Entity type:Organization
Organization Name:GARDEN STATE NEURO DIAGNOSTIC LABS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PA
Authorized Official - Prefix:
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LUBOLD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-736-8930
Mailing Address - Street 1:201 WOOLSTON DR
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19067-5008
Mailing Address - Country:US
Mailing Address - Phone:215-736-8930
Mailing Address - Fax:215-736-3093
Practice Address - Street 1:201 WOOLSTON DR
Practice Address - Street 2:
Practice Address - City:MORRISVILLE
Practice Address - State:PA
Practice Address - Zip Code:19067-5008
Practice Address - Country:US
Practice Address - Phone:215-736-8930
Practice Address - Fax:215-736-3093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-22
Last Update Date:2008-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty