Provider Demographics
NPI:1053446062
Name:DR. TEJAS P. DELIWALA NEUROLOGICAL CARE CENTER PA
Entity type:Organization
Organization Name:DR. TEJAS P. DELIWALA NEUROLOGICAL CARE CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TEJAS
Authorized Official - Middle Name:P
Authorized Official - Last Name:DELIWALA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-240-9222
Mailing Address - Street 1:3 PLAZA DR STE 13
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08757-3765
Mailing Address - Country:US
Mailing Address - Phone:732-240-9222
Mailing Address - Fax:732-240-9221
Practice Address - Street 1:3 PLAZA DR
Practice Address - Street 2:SUITE 13
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08757-3759
Practice Address - Country:US
Practice Address - Phone:732-240-9222
Practice Address - Fax:732-240-9221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA075571002084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1585592OtherAETNA
NJ4338191OtherCIGNA
NJ1585592OtherAETNA