Provider Demographics
NPI:1053447995
Name:WASHINTON TWP NEUROLOGY ASSOCIATES, PC
Entity Type:Organization
Organization Name:WASHINTON TWP NEUROLOGY ASSOCIATES, PC
Other - Org Name:WASHINGTON TOWNSHIP NEUROLOGY ASSOCIATES, PC
Other - Org Type:Other Name
Authorized Official - Title/Position:CHAIRMAN
Authorized Official - Prefix:DR
Authorized Official - First Name:PRAVIN
Authorized Official - Middle Name:B
Authorized Official - Last Name:VASOYA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:856-256-2600
Mailing Address - Street 1:GANTTOWN PROFESSIONAL PLAZA
Mailing Address - Street 2:438 GANTTOWN ROAD, SUITE B-3
Mailing Address - City:SEWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:08080
Mailing Address - Country:US
Mailing Address - Phone:856-256-2600
Mailing Address - Fax:856-256-2516
Practice Address - Street 1:GANTTOWN PROFESSIONAL PLAZA
Practice Address - Street 2:438 GANTTOWN ROAD, SUITE B-3
Practice Address - City:SEWELL
Practice Address - State:NJ
Practice Address - Zip Code:08080
Practice Address - Country:US
Practice Address - Phone:856-256-2600
Practice Address - Fax:856-256-2516
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA07368500261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJH21657Medicare UPIN