Organization
NEUROLOGIC DIAGNOSTICS, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEBRA QUINLAN (OFFICE MANAGER)
(215) 949-7925
Entity
Organization
Contact information
Practice address
333 NORTH OXFORD VALLEY ROAD, SUITE 503, FAIRLESS HILLS, PA 19030
(215) 949-7925
(215) 943-1304
Mailing address
PO BOX 450, LAFAYETTE HILL, PA 19444
(215) 949-7925
(215) 943-1304
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
MD066714L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0018063160002
—
PA
01
—
0737358000
INDEPENDENCE BLUE CROSS
PA
01
—
208576
HIGHMARK BLUE SHIELD
PA
01
—
2257478
AETNA
PA
Enumeration date
07/02/2006
Last updated
03/02/2016
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