Provider Demographics
NPI:1376618132
Name:MANASSAS NEUROLOGY ASSOCIATES PLLC
Entity Type:Organization
Organization Name:MANASSAS NEUROLOGY ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:AMY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-366-2799
Mailing Address - Street 1:8650 SUDLEY RD STE 309
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20110-4416
Mailing Address - Country:US
Mailing Address - Phone:703-366-2799
Mailing Address - Fax:703-366-2801
Practice Address - Street 1:8650 SUDLEY RD STE 309
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-4416
Practice Address - Country:US
Practice Address - Phone:703-366-2799
Practice Address - Fax:703-366-2801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010368992084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty