Provider Demographics
NPI:1336103688
Name:WEST BRANCH NEUROLOGY ASSOCIATES, PC
Entity Type:Organization
Organization Name:WEST BRANCH NEUROLOGY ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STUART
Authorized Official - Middle Name:MARTIN
Authorized Official - Last Name:OLINSKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:570-322-0990
Mailing Address - Street 1:425 MARKET STREET
Mailing Address - Street 2:FIRST FLOOR
Mailing Address - City:WILLIAMSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:17701-6345
Mailing Address - Country:US
Mailing Address - Phone:570-322-0990
Mailing Address - Fax:570-322-6087
Practice Address - Street 1:425 MARKET STREET
Practice Address - Street 2:FIRST FLOOR
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17701-6345
Practice Address - Country:US
Practice Address - Phone:570-322-0990
Practice Address - Fax:570-322-6087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD026303E2084N0400X
PAMA050972363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
Not Answered363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017437170003Medicaid
PA415955OtherBLUE SHIELD
PA024937Medicare ID - Type Unspecified