Provider Demographics
NPI:1811211105
Name:COMPREHENSIVE NEUROLOGY LLC
Entity type:Organization
Organization Name:COMPREHENSIVE NEUROLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAO
Authorized Official - Middle Name:S
Authorized Official - Last Name:PASUPULETI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-585-2666
Mailing Address - Street 1:1245 WHITEHORSE MERCERVILLE RD
Mailing Address - Street 2:SUITE 415
Mailing Address - City:TRENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08619-3831
Mailing Address - Country:US
Mailing Address - Phone:609-585-2666
Mailing Address - Fax:609-581-7901
Practice Address - Street 1:1245 WHITEHORSE MERCERVILLE RD
Practice Address - Street 2:SUITE 415
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08619-3831
Practice Address - Country:US
Practice Address - Phone:609-585-2666
Practice Address - Fax:609-581-9282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-16
Last Update Date:2010-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04107600174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ511110DAPOtherMEDICARE
NJ082058AKHOtherMEDICARE
NJ139910Medicaid
NJ0035319Medicaid
NJI10179Medicare UPIN
NJ139910Medicaid