Provider Demographics
NPI:1588733240
Name:NEUROLOGICAL REGIONAL ASSOCIATES, P.A.
Entity type:Organization
Organization Name:NEUROLOGICAL REGIONAL ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:YETTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-866-0466
Mailing Address - Street 1:504 ROUTE 38 E
Mailing Address - Street 2:
Mailing Address - City:MAPLE SHADE
Mailing Address - State:NJ
Mailing Address - Zip Code:08052-2039
Mailing Address - Country:US
Mailing Address - Phone:856-866-0466
Mailing Address - Fax:856-727-1483
Practice Address - Street 1:504 ROUTE 38 E
Practice Address - Street 2:
Practice Address - City:MAPLE SHADE
Practice Address - State:NJ
Practice Address - Zip Code:08052
Practice Address - Country:US
Practice Address - Phone:856-866-0466
Practice Address - Fax:856-727-1483
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2018-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2885506Medicaid
NJ2885506Medicaid