Provider Demographics
NPI:1346294170
Name:JERSEY SHORE NEUROLOGY ASSOCIATES, P.A.
Entity Type:Organization
Organization Name:JERSEY SHORE NEUROLOGY ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LYNDA
Authorized Official - Middle Name:L
Authorized Official - Last Name:TEBBS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-775-2400
Mailing Address - Street 1:1900 CORLIES AVE
Mailing Address - Street 2:
Mailing Address - City:NEPTUNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07753-4800
Mailing Address - Country:US
Mailing Address - Phone:732-775-2400
Mailing Address - Fax:732-775-5673
Practice Address - Street 1:1900 CORLIES AVE
Practice Address - Street 2:
Practice Address - City:NEPTUNE
Practice Address - State:NJ
Practice Address - Zip Code:07753-4800
Practice Address - Country:US
Practice Address - Phone:732-775-2400
Practice Address - Fax:732-775-5673
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2880903Medicaid