Healthcare Provider Details

I. General information

NPI: 1508803453
Provider Name (Legal Business Name): ALBERT SIMBUL SALVADOR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2112 S 7TH ST
PHILADELPHIA PA
19148-3213
US

IV. Provider business mailing address

2112 S 7TH ST
PHILADELPHIA PA
19148-3213
US

V. Phone/Fax

Practice location:
  • Phone: 215-467-7400
  • Fax: 215-467-7401
Mailing address:
  • Phone: 215-467-7400
  • Fax: 215-467-7401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License NumberMD021873E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: