Provider Demographics
NPI:1679688972
Name:NEUROLOGY CONSULTANTS OF BURLINGTON COUNTY, PA
Entity Type:Organization
Organization Name:NEUROLOGY CONSULTANTS OF BURLINGTON COUNTY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:RUBIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-261-7600
Mailing Address - Street 1:PO BOX 159
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08048-0159
Mailing Address - Country:US
Mailing Address - Phone:609-261-7600
Mailing Address - Fax:609-265-8205
Practice Address - Street 1:693 MAIN ST
Practice Address - Street 2:BUILDING D
Practice Address - City:LUMBERTON
Practice Address - State:NJ
Practice Address - Zip Code:08048-5043
Practice Address - Country:US
Practice Address - Phone:609-261-7600
Practice Address - Fax:609-265-8205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3419401Medicaid
NJ3419401Medicaid