MEDICARE: COMMUNITY NEUROLOGY ASSOCIATES PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084N0400X	Neurology Physician	MD045495M	PA
2	2084N0400X	Neurology Physician	25MA06559700	NJ
3	2084N0400X	Neurology Physician	MD062295L	PA
4	2084N0400X	Neurology Physician	MD2500056788	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	33423367	OTHER		AETNA GROUP #
2	3410492	OTHER		AETNA INDIV. PROV. #
3	3738422	OTHER		AETNA INDIV. PROV #
4	0437018000	OTHER		AMERIHEALTH PROVIDER #
5	1561458	OTHER	PA	BCBS GROUP #
6	2255911000	OTHER		KEYSTONE/AMERIHEALTH GROU
7	P3245151	OTHER		OXFORD HEALTH GROUP #
8	P61458	OTHER		AMERIHEALTH GROUP #
9	8547249	OTHER		CIGNA GROUP #
10	T1954659	OTHER	PA	BCBS INDIV. PROV #

General Provider Information

NPI Number	:	1205883782
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMUNITY NEUROLOGY ASSOCIATES PC

Provider Business Mailing Address
First Line	:	100 SPRINGDALE RD
Second Line	:	A3 #412
City	:	CHERRY HILL
State	:	NJ
Zip	:	08003-0000
Country	:	US
Telephone Number	:	856-616-8777
Fax Number	:	856-616-8780

Provider Business Practice Location Address
First Line	:	100 SPRINGDALE RD
Second Line	:	A3 #412
City	:	CHERRY HILL
State	:	NJ
Zip	:	08003-0000
Country	:	US
Telephone Number	:	856-616-8777
Fax Number	:	856-616-8780

Authorized Official
Title or Position	:	BILLING MANAGER
Name	:	MELISSA BETH TINKELMAN
Credential	:
Telephone Number	:	856-616-8777

Provider Enumeration Date	:	05/28/2006
Last Update Date	:	04/20/2008

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