Organization Active NPI

Clinical Neuropsychology Associates, P.C.

  • Clinical Neuropsychologist
  • Philadelphia, PA
National Provider Identifier
1972640928
Registry record updated Oct 5, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical NeuropsychologistTaxonomy code 103G00000X
License
004599L Issued in PA
Legal business name
CLINICAL NEUROPSYCHOLOGY ASSOCIATES, P.C.
Practice address
1528 Walnut St
Suite 1500
Philadelphia, PA 19102-3604
Phone
(215) 735-2505
Fax
(215) 735-2504
NPI assigned
Jan 31, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 5, 2010

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

Authorized official

Name
Edward Maitz, PHD
Title
Treasurer
Phone
(215) 735-2505

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical NeuropsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103G00000X 004599L PA Primary

Addresses

Primary practice location

1528 Walnut St
Suite 1500
Philadelphia, PA 19102-3604

Mailing address

PO Box 359
Furlong, PA 18925-0359
Phone (215) 735-2505

Other identifiers 1

IdentifierTypeStateIssuer
1687168OtherPAPA BLUE SHIELD GROUP NUMB

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20101018000329 PA Part B Supplier - Clinic/Group Practice 9234322785 Receives reassigned benefits from 1 practitioner
Practice locations: Blue Bell, PA

National Provider Directory

National Provider Directory

Locations

1000 White Horse Rd
Ste 408
Voorhees, NJ 08043
Phone (215) 735-2505

1717 Swede Rd
Ste 203
Blue Bell, PA 19422
Phone (215) 735-2505

1528 Walnut St
Ste 1500
Philadelphia, PA 19102
Phone (215) 735-2505

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1170201600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1286236800000",
    "number": "1972640928",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 359",
            "city": "FURLONG",
            "state": "PA",
            "postal_code": "189250359",
            "telephone_number": "215-735-2505",
            "fax_number": "215-735-2504"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1528 WALNUT ST",
            "address_2": "SUITE 1500",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191023604",
            "telephone_number": "215-735-2505",
            "fax_number": "215-735-2504"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLINICAL NEUROPSYCHOLOGY ASSOCIATES, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-31",
        "last_updated": "2010-10-05",
        "status": "A",
        "authorized_official_last_name": "MAITZ",
        "authorized_official_first_name": "EDWARD",
        "authorized_official_title_or_position": "TREASURER",
        "authorized_official_telephone_number": "215-735-2505",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Clinical Neuropsychologist",
            "state": "PA",
            "license": "004599L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PA BLUE SHIELD GROUP NUMB",
            "identifier": "1687168",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2010; 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.