Organization
ADVANCED NEUROLOGY CENTER LLC
Active
Organization
ADVANCED NEUROLOGY CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SRINIVASA POTLURI MD (PHYSICIAN)
(908) 218-1180
Entity
Organization
Contact information
Practice address
676 ROUTES 202 206 N, BLDG 2, SUITE 1NE, BRIDGEWATER, NJ 08807
(908) 218-1180
(908) 218-1718
Mailing address
PO BOX 1075, SOMERVILLE, NJ 08876-1075
(908) 218-1180
(908) 218-1718
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
MA07137500
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1545098
AMERIHEALTH
—
01
—
2229034000
KEYSTONE
—
01
—
2K4368
HEALTHNET
—
01
—
60008696
HORIZON NJ HEALTH
—
05
—
8686301
—
NJ
01
—
P2486490
OXFORD
—
Enumeration date
08/03/2006
Last updated
08/22/2020
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