The New Jersey Institute of Neurobehavior, LLC

Primary specialty

Clinical NeuropsychologistTaxonomy code 103G00000X

License

1838 Issued in NJ

Legal business name

THE NEW JERSEY INSTITUTE OF NEUROBEHAVIOR, LLC

Practice address

665 Martinsville Rd
Riverwalk Village Center, Suite 218
Basking Ridge, NJ 07920-4700

Phone

(908) 604-1100

Fax

(908) 607-1866

NPI assigned

Jun 19, 2007

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. James Bragonier Gillock, ED.D.

Title

Director of Clinical Services

Phone

(908) 604-1100

Specialties & licenses 1

Addresses

Tax ID family

The New Jersey Institute of Neurbehavior2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• The New Jersey Institute of Neurbehavior

  • Clinical Neuropsychologist
  • Basking Ridge, NJ
  • NPI 1083727622
  NPD tax ID

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1182211200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1033314133",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "665 MARTINSVILLE RD",
            "address_2": "RIVERWALK VILLAGE CENTER, SUITE 218",
            "city": "BASKING RIDGE",
            "state": "NJ",
            "postal_code": "079204700",
            "telephone_number": "908-604-1100",
            "fax_number": "908-607-1866"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "665 MARTINSVILLE RD",
            "address_2": "RIVERWALK VILLAGE CENTER, SUITE 218",
            "city": "BASKING RIDGE",
            "state": "NJ",
            "postal_code": "079204700",
            "telephone_number": "908-604-1100",
            "fax_number": "908-607-1866"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE NEW JERSEY INSTITUTE OF NEUROBEHAVIOR, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-19",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "GILLOCK",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "BRAGONIER",
        "authorized_official_title_or_position": "DIRECTOR OF CLINICAL SERVICES",
        "authorized_official_telephone_number": "908-604-1100",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "ED.D."
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "NJ",
            "license": "1838",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Neuropsychologist in Basking Ridge, NJ
• Providers in Basking Ridge, NJ by specialty
• Clinical Neuropsychologist in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.