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General NPI Number Information
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NPI Number | 1710924956
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Entity Type | Organization
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Legal Business Name | CHILD NEUROLOGY LLC
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Dates
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Enumeration Date | 05/31/2006
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Last Update Date | 05/16/2008
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Provider Practice Location Address
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Address Line | 4440 SHERIDAN STREET
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City | HOLLYWOOD
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State | FL
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Zip | 33021
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Country | US
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Telephone | 954-961-2423
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Fax | 954-961-4860
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Provider Business Mailing Address
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Address Line | 4440 SHERIDAN STREET
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City | HOLLYWOOD
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State | FL
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Zip | 33021
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Country | US
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Telephone | 954-961-2423
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Fax | 954-961-4860
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Authorized Official
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Title or Position | MANAGER OF THE CHILD NEUROLOGY LLC
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Name | DR. TATYANA DUBROVSKY
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Credential | MD
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Telephone | 954-961-2423
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0402X
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Taxonomy Name | Neurology with Special Qualifications in Child Neurology Physician
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License Number | ME70907
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License Number State | FL
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