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General NPI Number Information
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NPI Number | 1962803031
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Entity Type | Organization
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Legal Business Name | SUBURBAN MULTISPECIALTY LIMITED, LLC
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Dates
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Enumeration Date | 09/09/2014
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Last Update Date | 09/09/2014
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Provider Practice Location Address
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Address Line | 1 BELMONT AVENUE SUITE 416
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City | BALA CYNWYD
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State | PA
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Zip | 19004-1607
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Country | US
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Telephone | 610-667-4080
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Fax | 610-667-2748
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Provider Business Mailing Address
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Address Line | 1 BELMONT AVENUE SUITE 416
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City | BALA CYNWYD
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State | PA
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Zip | 19004-1607
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Country | US
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Telephone | 610-667-4080
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Fax | 610-667-2748
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | MRS. DINA JEAN DUBROW
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Credential |
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Telephone | 610-667-4080
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207YS0123X
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Taxonomy Name | Facial Plastic Surgery Physician
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License Number | OS.015962
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | OS-009268L
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License Number State | PA
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