Provider Demographics
NPI:1801829619
Name:NEUROLOGIC ARTS ASSOCIATED, LLC
Entity type:Organization
Organization Name:NEUROLOGIC ARTS ASSOCIATED, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BERNARD
Authorized Official - Middle Name:M
Authorized Official - Last Name:WEINTRAUB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:570-296-5188
Mailing Address - Street 1:104 BENNETT AVE
Mailing Address - Street 2:SUITE 2B
Mailing Address - City:MILFORD
Mailing Address - State:PA
Mailing Address - Zip Code:18337-9759
Mailing Address - Country:US
Mailing Address - Phone:570-296-5188
Mailing Address - Fax:570-296-2296
Practice Address - Street 1:104 BENNETT AVE
Practice Address - Street 2:SUITE 2B
Practice Address - City:MILFORD
Practice Address - State:PA
Practice Address - Zip Code:18337-9759
Practice Address - Country:US
Practice Address - Phone:570-296-5188
Practice Address - Fax:570-296-2296
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2011-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA107490Medicare PIN