Provider Demographics
NPI:1659302750
Name:NEUROLOGICAL MANAGEMENT GROUP, INC
Entity Type:Organization
Organization Name:NEUROLOGICAL MANAGEMENT GROUP, INC
Other - Org Name:THE WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SPECIALIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:TOMAR
Authorized Official - Last Name:HUBBARD
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:856-275-7688
Mailing Address - Street 1:55 E CUTHBERT BLVD
Mailing Address - Street 2:
Mailing Address - City:HADDON TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08108-2021
Mailing Address - Country:US
Mailing Address - Phone:856-275-7688
Mailing Address - Fax:856-833-1154
Practice Address - Street 1:55 E CUTHBERT BLVD
Practice Address - Street 2:
Practice Address - City:HADDON TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08108-2021
Practice Address - Country:US
Practice Address - Phone:856-275-7688
Practice Address - Fax:856-833-1154
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2011-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB07214800305S00000X
NJ25MA07709400305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJH32980Medicare UPIN