Center for Neurologic Specialty

Primary specialty

Neurology PhysicianTaxonomy code 2084N0400X

License

MA59597 Issued in NJ

Legal business name

CENTER FOR NEUROLOGIC SPECIALTY

Practice address

12000 Lincoln Dr W
Suite 204
Marlton, NJ 08053-3402

Phone

(856) 988-3444

Fax

(856) 988-0553

NPI assigned

Oct 29, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Ricardo Y Mabanta, M.D.NPI 1730130840

Title

Partner

Phone

(856) 988-3444

Specialties & licenses 1

Addresses

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.

• Ricardo Y Mabanta, MD

  • Neurology Physician
  • Marlton, NJ
  • NPI 1730130840
  NPD (past) Authorized official

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

{
    "created_epoch": "1193616000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1233878400000",
    "number": "1972782704",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "53 NORMANDY RD",
            "city": "MARLTON",
            "state": "NJ",
            "postal_code": "080535527",
            "telephone_number": "856-988-3444",
            "fax_number": "856-988-0553"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12000 LINCOLN DR W",
            "address_2": "SUITE 204",
            "city": "MARLTON",
            "state": "NJ",
            "postal_code": "080533402",
            "telephone_number": "856-988-3444",
            "fax_number": "856-988-0553"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTER FOR NEUROLOGIC SPECIALTY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-29",
        "last_updated": "2009-02-06",
        "status": "A",
        "authorized_official_last_name": "MABANTA",
        "authorized_official_first_name": "RICARDO",
        "authorized_official_middle_name": "Y",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "856-988-3444",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "NJ",
            "license": "MA59597",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Neurology Physician in Marlton, NJ
• Providers in Marlton, NJ by specialty
• Neurology Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.