Healthcare Provider Details

I. General information

NPI: 1659302750
Provider Name (Legal Business Name): NEUROLOGICAL MANAGEMENT GROUP, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 07/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 E CUTHBERT BLVD
HADDON TOWNSHIP NJ
08108-2021
US

IV. Provider business mailing address

55 E CUTHBERT BLVD
HADDON TOWNSHIP NJ
08108-2021
US

V. Phone/Fax

Practice location:
  • Phone: 856-275-7688
  • Fax: 856-833-1154
Mailing address:
  • Phone: 856-275-7688
  • Fax: 856-833-1154

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number25MA07709400
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number25MB07214800
License Number StateNJ

VIII. Authorized Official

Name: DR. SEAN TOMAR HUBBARD
Title or Position: SPECIALIST
Credential: D.O
Phone: 856-275-7688