Provider Demographics
NPI:1255931804
Name:NEUROGENICSS, LLC.
Entity type:Organization
Organization Name:NEUROGENICSS, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHALOFSKY
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:215-826-3301
Mailing Address - Street 1:17 BLACKSMITH RD STE D9
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18940-2065
Mailing Address - Country:US
Mailing Address - Phone:215-826-3301
Mailing Address - Fax:
Practice Address - Street 1:17 BLACKSMITH RD STE D9
Practice Address - Street 2:
Practice Address - City:NEWTOWN
Practice Address - State:PA
Practice Address - Zip Code:18940-2065
Practice Address - Country:US
Practice Address - Phone:215-826-3301
Practice Address - Fax:215-798-9647
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-31
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty