Organization
CENTER FOR NEUROLOGIC SPECIALTY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RICARDO Y MABANTA M.D. (PARTNER)
(856) 988-3444
Entity
Organization
Contact information
Practice address
12000 LINCOLN DR W, SUITE 204, MARLTON, NJ 08053-3402
(856) 988-3444
(856) 988-0553
Mailing address
53 NORMANDY RD, MARLTON, NJ 08053-5527
(856) 988-3444
(856) 988-0553
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
MA59597
NJ
Other
Enumeration date
10/29/2007
Last updated
02/06/2009
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