MEDICARE: AYBALA OZTURK LSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	SW132785	PA

General Provider Information

NPI Number	:	1023482718
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AYBALA OZTURK LSW

Provider Business Mailing Address
First Line	:	602 N 16TH ST
Second Line	:	APT T
City	:	PHILADELPHIA
State	:	PA
Zip	:	19130-3423
Country	:	US
Telephone Number	:	573-639-0202
Fax Number	:

Provider Business Practice Location Address
First Line	:	602 N 16TH ST
Second Line	:	APT T
City	:	PHILADELPHIA
State	:	PA
Zip	:	19130-3423
Country	:	US
Telephone Number	:	573-639-0202
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/19/2015
Last Update Date	:	11/19/2015

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