Provider Demographics
NPI:1700954922
Name:NEUROLOGY ASSOCIATES LTD
Entity Type:Organization
Organization Name:NEUROLOGY ASSOCIATES LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:RITA
Authorized Official - Middle Name:
Authorized Official - Last Name:GRISOLIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-463-3349
Mailing Address - Street 1:1514 WOLF ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19145-4441
Mailing Address - Country:US
Mailing Address - Phone:215-463-3349
Mailing Address - Fax:215-463-0131
Practice Address - Street 1:1514 WOLF ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19145-4441
Practice Address - Country:US
Practice Address - Phone:215-463-3349
Practice Address - Fax:215-463-0131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD010079E2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0006768340001Medicaid
PA095064Medicare ID - Type UnspecifiedGROUP MEDICARE NUMBER