Provider Demographics
NPI:1023052727
Name:NEUROLOGY ASSOCIATES, PA
Entity type:Organization
Organization Name:NEUROLOGY ASSOCIATES, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LANNY
Authorized Official - Middle Name:
Authorized Official - Last Name:EDELSOHN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:302-731-3017
Mailing Address - Street 1:774 CHRISTIANA RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-4236
Mailing Address - Country:US
Mailing Address - Phone:302-731-3017
Mailing Address - Fax:
Practice Address - Street 1:774 CHRISTIANA RD
Practice Address - Street 2:SUITE 1
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-4236
Practice Address - Country:US
Practice Address - Phone:302-731-3017
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FDX017OtherIDTF NUMBER
DE152702Medicaid
DE152702Medicaid