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General NPI Number Information
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NPI Number | 1447218433
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Entity Type | Organization
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Legal Business Name | LIBERTY EYE SURGICAL CENTER LLC
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Dates
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Enumeration Date | 05/02/2006
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Last Update Date | 12/09/2010
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Provider Practice Location Address
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Address Line | 9122 BLUE GRASS RD
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City | PHILADELPHIA
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State | PA
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Zip | 19114-3202
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Country | US
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Telephone | 215-673-9231
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Fax | 215-673-9236
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Provider Business Mailing Address
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Address Line | 9122 BLUE GRASS RD
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City | PHILADELPHIA
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State | PA
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Zip | 19114-3202
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Country | US
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Telephone | 215-673-9231
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Fax | 215-673-9236
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. DENNIS SLOCHOWER
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Credential | M.D.
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Telephone | 215-673-9231
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 17401501
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License Number State | PA
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