Organization
CLINICAL NEUROPHYSIOLOGY & EPILEPSY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LYDIA SHAJENKO M.D., PH.D (DIRECTOR OWNER)
(646) 245-6180
Entity
Organization
Contact information
Practice address
725 RIVER RD, SUITE.106, EDGEWATER, NJ 07020-1171
(201) 943-2273
(201) 215-9548
Mailing address
725 RIVER RD, SUITE.106, EDGEWATER, NJ 07020-1171
(201) 943-2273
(201) 215-9548
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
25MA08061700
NJ
2084N0600X
Clinical Neurophysiology Physician
Primary
25MA08061700
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0148083
—
NJ
Enumeration date
05/12/2006
Last updated
07/23/2008
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