Provider Demographics
NPI:1306875299
Name:NEUROLOGIC DIAGNOSTICS, P.C.
Entity type:Organization
Organization Name:NEUROLOGIC DIAGNOSTICS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:QUINLAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-949-7925
Mailing Address - Street 1:PO BOX 450
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE HILL
Mailing Address - State:PA
Mailing Address - Zip Code:19444
Mailing Address - Country:US
Mailing Address - Phone:215-949-7925
Mailing Address - Fax:215-943-1304
Practice Address - Street 1:333 NORTH OXFORD VALLEY ROAD
Practice Address - Street 2:SUITE 503
Practice Address - City:FAIRLESS HILLS
Practice Address - State:PA
Practice Address - Zip Code:19030
Practice Address - Country:US
Practice Address - Phone:215-949-7925
Practice Address - Fax:215-943-1304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2016-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD066714L2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0737358000OtherINDEPENDENCE BLUE CROSS
PA2257478OtherAETNA
PA208576OtherHIGHMARK BLUE SHIELD
PA0018063160002Medicaid
PAG88903Medicare UPIN