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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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