Basic Information
| Provider Information | |||||||||
| NPI: | 1609863950 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LANCASTER NEUROSCIENCE & SPINE ASSOCIATES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1671 CROOKED OAK DR | ||||||||
| Address2: | |||||||||
| City: | LANCASTER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 176014269 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7175695331 | ||||||||
| FaxNumber: | 7175694210 | ||||||||
| Practice Location | |||||||||
| Address1: | 1671 CROOKED OAK DR | ||||||||
| Address2: | |||||||||
| City: | LANCASTER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 176014269 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7175695331 | ||||||||
| FaxNumber: | 7175694210 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/03/2005 | ||||||||
| LastUpdateDate: | 06/16/2014 | ||||||||
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| AuthorizedOfficialLastName: | KURTZ | ||||||||
| AuthorizedOfficialFirstName: | STEPHANIE | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 7175695331 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | 207T00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Neurological Surgery |
ID Information
| ID | Type | State | Issuer | Description | 1007359470002 | 05 | PA | MEDICAID |