Provider Demographics
NPI:1659542025
Name:ADVANCED NEUROLOGY ASSOCIATES, PC
Entity Type:Organization
Organization Name:ADVANCED NEUROLOGY ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEPHARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MBA, HHP
Authorized Official - Phone:215-574-3573
Mailing Address - Street 1:822 PINE ST
Mailing Address - Street 2:SUITE 3C
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-6187
Mailing Address - Country:US
Mailing Address - Phone:215-574-3573
Mailing Address - Fax:215-574-3645
Practice Address - Street 1:822 PINE ST
Practice Address - Street 2:SUITE 3C
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-6187
Practice Address - Country:US
Practice Address - Phone:215-574-3573
Practice Address - Fax:215-574-3645
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-13
Last Update Date:2010-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
9015156OtherAETNA PPO
PA3504822000OtherPC/KHPE/IBC
PA2030376OtherHIGHMARK
PA1821920OtherAETNA HMO
PA3504822000OtherPC/KHPE/IBC