1326014044 NPI number — NEUROLOGIC CONSULTANT OF NWPA PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326014044 NPI number — NEUROLOGIC CONSULTANT OF NWPA PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEUROLOGIC CONSULTANT OF NWPA 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:
1326014044
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
110 FAIRFIELD DRIVE
Provider Second Line Business Mailing Address:
PO BOX 549
Provider Business Mailing Address City Name:
SENECA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16346-0549
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
814-678-0080
Provider Business Mailing Address Fax Number:
814-678-1106

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
110 FAIRFIELD DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SENECA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16346-0549
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-678-0080
Provider Business Practice Location Address Fax Number:
814-678-1106
Provider Enumeration Date:
02/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MCLAUGHLIN
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
ROBERT
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
814-678-0080

Provider Taxonomy Codes

  • Taxonomy code: 2084N0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0019011550003 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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