1972640928 NPI number — CLINICAL NEUROPSYCHOLOGY ASSOCIATES, P.C.

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 1972640928 NPI number — CLINICAL NEUROPSYCHOLOGY ASSOCIATES, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CLINICAL NEUROPSYCHOLOGY ASSOCIATES, P.C.
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:
1972640928
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/05/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 359
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FURLONG
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18925-0359
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-735-2505
Provider Business Mailing Address Fax Number:
215-735-2504

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1528 WALNUT ST
Provider Second Line Business Practice Location Address:
SUITE 1500
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19102-3604
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-735-2505
Provider Business Practice Location Address Fax Number:
215-735-2504
Provider Enumeration Date:
01/31/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MAITZ
Authorized Official First Name:
EDWARD
Authorized Official Middle Name:
Authorized Official Title or Position:
TREASURER
Authorized Official Telephone Number:
215-735-2505

Provider Taxonomy Codes

  • Taxonomy code: 103G00000X , with the licence number:  004599L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1687168 . This is a "PA BLUE SHIELD GROUP NUMB" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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