Provider Demographics
NPI:1699031385
Name:NEUROTEC MEDICAL ASSOCIATES, PC
Entity Type:Organization
Organization Name:NEUROTEC MEDICAL ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:BACA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-630-2108
Mailing Address - Street 1:333 OXFORD VALLEY ROAD
Mailing Address - Street 2:SUITE 302
Mailing Address - City:FAIRLESS HILLS
Mailing Address - State:PA
Mailing Address - Zip Code:19030-9541
Mailing Address - Country:US
Mailing Address - Phone:973-451-8248
Mailing Address - Fax:973-451-9541
Practice Address - Street 1:333 OXFORD VALLEY ROAD
Practice Address - Street 2:SUITE 302
Practice Address - City:FAIRLESS HILLS
Practice Address - State:PA
Practice Address - Zip Code:19030-9541
Practice Address - Country:US
Practice Address - Phone:973-451-8248
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-06
Last Update Date:2012-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty