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General NPI Number Information
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NPI Number | 1386048197
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Entity Type | Organization
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Legal Business Name | PREVENTION CENTER LLC
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Dates
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Enumeration Date | 10/22/2014
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Last Update Date | 10/22/2014
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Provider Practice Location Address
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Address Line | 1999 SPROUL RD SUITE 21
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City | BROOMALL
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State | PA
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Zip | 19008-3508
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Country | US
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Telephone | 610-353-5840
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Fax | 610-353-3420
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Provider Business Mailing Address
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Address Line | 1999 SPROUL RD SUITE 21
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City | BROOMALL
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State | PA
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Zip | 19008-3508
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Country | US
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Telephone | 610-353-5840
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Fax | 610-353-3420
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. LEON GREGORY DE MASI
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Credential | MD
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Telephone | 610-353-5840
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2083P0901X
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Taxonomy Name | Public Health & General Preventive Medicine Physician
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License Number | MD025728E
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License Number State | PA
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