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General NPI Number Information
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NPI Number | 1740448711
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Entity Type | Organization
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Legal Business Name | TREVOSE SPECIALTY CARE SURGICAL CENTER, LLC
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Dates
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Enumeration Date | 05/27/2008
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Last Update Date | 06/21/2018
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Provider Practice Location Address
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Address Line | 4979 OLD STREET RD
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City | TREVOSE
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State | PA
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Zip | 19053-6222
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Country | US
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Telephone | 267-684-6047
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Fax | 267-684-6056
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Provider Business Mailing Address
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Address Line | 4979 OLD STREET RD
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City | TREVOSE
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State | PA
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Zip | 19053-6222
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Country | US
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Telephone | 267-684-6047
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Fax | 267-684-6056
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | STEVEN ROSEN
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Credential | MD
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Telephone | 267-684-6047
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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 | 22411501
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License Number State | PA
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