Organization Active NPI

Neurological Institute of Northern New Jersey

  • Neurology Physician
  • Livingston, NJ
National Provider Identifier
1487059978
Registry record updated Apr 17, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
License
272570-1 Issued in NY
Legal business name
NEUROLOGICAL INSTITUTE OF NORTHERN NEW JERSEY
Practice address
340 E Northfield Rd Ste 1B
Livingston, NJ 07039-4892
Phone
(973) 974-9946
Fax
(973) 500-4411
NPI assigned
Oct 27, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 17, 2023

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

Authorized official

Name
Guha Venkatraman, M.D.NPI 1356517593
Title
President
Phone
(973) 255-8920

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2084N0400X 272570-1 NY Primary

Addresses

Primary practice location

340 E Northfield Rd Ste 1B
Livingston, NJ 07039-4892

Mailing address

340 E Northfield Rd Ste 1B
Livingston, NJ 07039-4892
Phone (973) 974-9946

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150721001466 NJ Part B Supplier - Clinic/Group Practice 3173836020 Receives reassigned benefits from 2 practitioners
Practice locations: Livingston, NJ; West Orange, NJ

National Provider Directory

National Provider Directory

Locations

340 E Northfield Rd
Ste 1B
Livingston, NJ 07039
Phone (201) 994-0880

340 E Northfield Rd
Livingston, NJ 07039
Phone (973) 992-1811

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1414368000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1681689600000",
    "number": "1487059978",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "340 E NORTHFIELD RD STE 1B",
            "city": "LIVINGSTON",
            "state": "NJ",
            "postal_code": "070394892",
            "telephone_number": "973-974-9946",
            "fax_number": "973-500-4411"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "340 E NORTHFIELD RD STE 1B",
            "city": "LIVINGSTON",
            "state": "NJ",
            "postal_code": "070394892",
            "telephone_number": "973-974-9946",
            "fax_number": "973-500-4411"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEUROLOGICAL INSTITUTE OF NORTHERN NEW JERSEY",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-10-27",
        "last_updated": "2023-04-17",
        "certification_date": "2023-04-17",
        "status": "A",
        "authorized_official_last_name": "VENKATRAMAN",
        "authorized_official_first_name": "GUHA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "973-255-8920",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "NY",
            "license": "272570-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Livingston, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.