Provider Demographics
NPI:1265530851
Name:ASSOCIATED NEUROLOGISTS OF N.J., PA
Entity type:Organization
Organization Name:ASSOCIATED NEUROLOGISTS OF N.J., PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TRACI
Authorized Official - Middle Name:LYN
Authorized Official - Last Name:CAMISO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-581-2708
Mailing Address - Street 1:1245 WHITEHORSE MERCERVILLE RD
Mailing Address - Street 2:SUITE 415
Mailing Address - City:HAMILTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08619-3831
Mailing Address - Country:US
Mailing Address - Phone:609-581-2300
Mailing Address - Fax:609-581-7901
Practice Address - Street 1:1245 WHITEHORSE MERCERVILLE RD
Practice Address - Street 2:SUITE 415
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08619-3831
Practice Address - Country:US
Practice Address - Phone:609-581-2300
Practice Address - Fax:609-581-7901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA041076002084N0400X, 2084N0402X, 2084N0600X
NJ25MA057663002084N0400X, 2084N0600X
NJ25MA072284002084N0400X, 2084N0600X
NJ25MA078847002084N0400X, 2084N0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Not Answered2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child NeurologyGroup - Single Specialty
Not Answered2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical NeurophysiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3426807Medicaid
NJI42977Medicare UPIN
NJ746043Medicare ID - Type UnspecifiedGROUP ID #
NJH31739Medicare UPIN
NJ3426807Medicaid
NJF57476Medicare UPIN