Basic Information
| Provider Information | |||||||||
| NPI: | 1538105457 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NEUROLOGY CONSULTANTS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1415 E ROUTE 70 | ||||||||
| Address2: | SUITE 204 | ||||||||
| City: | CHERRY HILL | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 08034 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8567952000 | ||||||||
| FaxNumber: | 8567953625 | ||||||||
| Practice Location | |||||||||
| Address1: | 1415 E ROUTE 70 | ||||||||
| Address2: | SUITE 204 | ||||||||
| City: | CHERRY HILL | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 08034 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8567952000 | ||||||||
| FaxNumber: | 8567953625 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/20/2006 | ||||||||
| LastUpdateDate: | 05/12/2009 | ||||||||
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| AuthorizedOfficialLastName: | LIPSIUS | ||||||||
| AuthorizedOfficialFirstName: | BRUCE | ||||||||
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| AuthorizedOfficialTitleorPosition: | PHYSICIAN/ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 8567952000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0400X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
ID Information
| ID | Type | State | Issuer | Description | 3413101 | 05 | NJ | MEDICAID | CB0073 | 01 | NJ | MEDICARE ID | OTHER |