1205883782 NPI number — COMMUNITY NEUROLOGY ASSOCIATES PC

Table of content: (NPI 1205883782)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205883782 NPI number — COMMUNITY NEUROLOGY ASSOCIATES PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMMUNITY NEUROLOGY ASSOCIATES PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205883782
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 SPRINGDALE RD
Provider Second Line Business Mailing Address:
A3 #412
Provider Business Mailing Address City Name:
CHERRY HILL
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08003-0000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-616-8777
Provider Business Mailing Address Fax Number:
856-616-8780

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 SPRINGDALE RD
Provider Second Line Business Practice Location Address:
A3 #412
Provider Business Practice Location Address City Name:
CHERRY HILL
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08003-0000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-616-8777
Provider Business Practice Location Address Fax Number:
856-616-8780
Provider Enumeration Date:
05/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
TINKELMAN
Authorized Official First Name:
MELISSA
Authorized Official Middle Name:
BETH
Authorized Official Title or Position:
BILLING MANAGER
Authorized Official Telephone Number:
856-616-8777

Provider Taxonomy Codes

  • Taxonomy code: 2084N0400X , with the licence number:  MD045495M , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084N0400X , with the licence number: MD2500056788 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2084N0400X , with the licence number: 25MA06559700 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084N0400X , with the licence number: MD062295L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 33423367 . This is a "AETNA GROUP #" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3410492 . This is a "AETNA INDIV. PROV. #" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3738422 . This is a "AETNA INDIV. PROV #" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0437018000 . This is a "AMERIHEALTH PROVIDER #" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1561458 . This is a "BCBS GROUP #" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2255911000 . This is a "KEYSTONE/AMERIHEALTH GROU" identifier . This identifiers is of the category "OTHER".
  • Identifier: P3245151 . This is a "OXFORD HEALTH GROUP #" identifier . This identifiers is of the category "OTHER".
  • Identifier: P61458 . This is a "AMERIHEALTH GROUP #" identifier . This identifiers is of the category "OTHER".
  • Identifier: 8547249 . This is a "CIGNA GROUP #" identifier . This identifiers is of the category "OTHER".
  • Identifier: T1954659 . This is a "BCBS INDIV. PROV #" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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