Provider Demographics
NPI:1356642573
Name:LOURDES MEDICAL ASSOCIATES, P. A.
Entity Type:Organization
Organization Name:LOURDES MEDICAL ASSOCIATES, P. A.
Other - Org Name:LOURDES MEDICAL ASSOCIATES-NEUROLOGY CONSULTANTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:FOX
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:856-796-9200
Mailing Address - Street 1:500 GROVE ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:HADDON HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:08035-1761
Mailing Address - Country:US
Mailing Address - Phone:856-796-9200
Mailing Address - Fax:856-310-0592
Practice Address - Street 1:63 KRESSON RD
Practice Address - Street 2:SUITE 101
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08034-3200
Practice Address - Country:US
Practice Address - Phone:856-795-2000
Practice Address - Fax:856-795-3625
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LOURDES MEDICAL ASSOCIATES, PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-11-04
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB028857002084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6535704Medicaid
NJ6535704Medicaid