Lakeside Neurology & Radiology of New Jersey PC

Primary specialty

SpecialistTaxonomy code 174400000X

License

25MA07746800 Issued in NJ

Legal business name

LAKESIDE NEUROLOGY & RADIOLOGY OF NEW JERSEY PC

Practice address

1 Gateway Ctr
#2600
Newark, NJ 07102-5310

Phone

(847) 510-0530

Fax

(888) 317-4206

NPI assigned

Sep 19, 2007

Organization subpart

No

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

Authorized official

Name

Mr. Tom G Winger

Title

Director

Phone

(847) 510-0530

Specialties & licenses 1

Addresses

Other names 1

• Lakeside Neurology Of New Jersey Doing business as

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

{
    "created_epoch": "1190160000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1257984000000",
    "number": "1356537708",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 GATEWAY CTR",
            "address_2": "#2600",
            "city": "NEWARK",
            "state": "NJ",
            "postal_code": "071025310",
            "telephone_number": "847-510-0530",
            "fax_number": "888-317-4206"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 GATEWAY CTR",
            "address_2": "#2600",
            "city": "NEWARK",
            "state": "NJ",
            "postal_code": "071025310",
            "telephone_number": "847-510-0530",
            "fax_number": "888-317-4206"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKESIDE NEUROLOGY & RADIOLOGY OF NEW JERSEY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-19",
        "last_updated": "2009-11-12",
        "status": "A",
        "authorized_official_last_name": "WINGER",
        "authorized_official_first_name": "TOM",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "847-510-0530",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "NJ",
            "license": "25MA07746800",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lakeside Neurology Of New Jersey",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Specialist in Newark, NJ
• Providers in Newark, NJ by specialty
• Specialist in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2009; 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.