Provider Demographics
NPI:1679637243
Name:KEYSTONE NEUROLOGY CONSULTANTS, P.C.
Entity Type:Organization
Organization Name:KEYSTONE NEUROLOGY CONSULTANTS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTONIO
Authorized Official - Middle Name:
Authorized Official - Last Name:SOTOMAYOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-323-9505
Mailing Address - Street 1:1220 CENTRE AVE
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19601-1458
Mailing Address - Country:US
Mailing Address - Phone:610-323-9505
Mailing Address - Fax:
Practice Address - Street 1:1569 MEDICAL DR
Practice Address - Street 2:SUITE 201
Practice Address - City:POTTSTOWN
Practice Address - State:PA
Practice Address - Zip Code:19464-3223
Practice Address - Country:US
Practice Address - Phone:610-323-9505
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2014-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA677878Medicare PIN
PA677878Medicare ID - Type Unspecified