Active NPI
Clinical Neuropsychology Associates, P.C.
- Clinical Neuropsychologist
- Philadelphia, PA
National Provider Identifier
1972640928
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Neuropsychologist
- License
- 004599L
- 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
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) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Neuropsychologist | 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
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1687168 | Other | PA | PA BLUE SHIELD GROUP NUMB |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in PA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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 DirectoryLocations
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
- Clinical Care Associates of the University of Pennsylvania Health Syst
- Clinical Health Care Associates of New Jersey, PC
- Clinical Health Care Associates of New Jersey, PC
- Clinical Nephrology Assoc Inc PC
- Clinical Nephrology Associates, LTD.
- Clinical Research Philadelphia, LLC
- Nichelle Yvette Clinkscale, RPH
- Clinton Endocrine Laboratory
- Sara Clipp, CRNP
- Cliveden Center, LLC
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.