Penn Neurology and Psychiatry Associates, PC

Primary specialty

SpecialistTaxonomy code 174400000X

License

MD052377L Issued in PA

Legal business name

PENN NEUROLOGY AND PSYCHIATRY ASSOCIATES, PC

Practice address

340 Montage Mountain Rd
Suite D
Moosic, PA 18507-1782

Phone

(570) 909-9411

Fax

(866) 259-6004

NPI assigned

Sep 15, 2006

Last updated

Jun 29, 2015By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Iqbal Khan, M.D.NPI 1083603062

Title

President

Phone

(570) 909-9411

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in PA

Enrollment records 1

Tax ID family

Penn Neurology and Psychiatry Associates PC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Penn Neurology and Psychiatry Associates, PC

  • Neurology Physician
  • Mountain Top, PA
  • NPI 1467547208
  NPD tax ID

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Iqbal Ahmad Khan, M.D.

  • Neurology Physician
  • Moosic, PA
  • NPI 1083603062
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158278400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1435536000000",
    "number": "1629174842",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "340 MONTAGE MOUNTAIN RD",
            "address_2": "SUITE D",
            "city": "MOOSIC",
            "state": "PA",
            "postal_code": "185071782",
            "telephone_number": "570-909-9411",
            "fax_number": "866-259-6004"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "340 MONTAGE MOUNTAIN RD",
            "address_2": "SUITE D",
            "city": "MOOSIC",
            "state": "PA",
            "postal_code": "185071782",
            "telephone_number": "570-909-9411",
            "fax_number": "866-259-6004"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PENN NEUROLOGY AND PSYCHIATRY ASSOCIATES, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-15",
        "last_updated": "2015-06-29",
        "status": "A",
        "authorized_official_last_name": "KHAN",
        "authorized_official_first_name": "IQBAL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "570-909-9411",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "PA",
            "license": "MD065153L",
            "primary": false
        },
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "PA",
            "license": "MD052377L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1011631480001",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Andrea J Oravec, LCSW
• Zuhri Outland, LSW
• Amber Michele Parker, PMHNP-BC
• Thomas Anthony Patts, PA-C
• Samantha Lynn Pavolko
• Travis Edward Perry, D.D.S
• Sarah Pilosi
• Rachel Platko, LPC
• James Oliver Poepperling, DPT, L.AC.
• Lynn Marie Pons, LCSW

• Specialist in Moosic, PA
• Providers in Moosic, PA by specialty
• Specialist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.