Healthcare Provider Details

I. General information

NPI: 1700976404
Provider Name (Legal Business Name): SUBURBAN MULTISPECIALTY LIMITED, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 07/31/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BELMONT AVE SUITE 416
BALA CYNWYD PA
19004-1617
US

IV. Provider business mailing address

1 BELMONT AVE SUITE 416
BALA CYNWYD PA
19004-1617
US

V. Phone/Fax

Practice location:
  • Phone: 610-667-4080
  • Fax: 610-667-2748
Mailing address:
  • Phone: 610-667-4080
  • Fax: 610-667-2748

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State

VIII. Authorized Official

Name: DR. ANDREW SCOTT KIRSCHNER
Title or Position: PRESIDENT/OWNER
Credential: D.O.
Phone: 610-667-4080