Provider Demographics
NPI:1194813444
Name:A & M SUPER NOVA PC
Entity type:Organization
Organization Name:A & M SUPER NOVA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:STARIKOV
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:215-671-9150
Mailing Address - Street 1:9150 MARSHALL ST
Mailing Address - Street 2:SUITE 18
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19114-2217
Mailing Address - Country:US
Mailing Address - Phone:215-671-9150
Mailing Address - Fax:215-671-9160
Practice Address - Street 1:9150 MARSHALL ST
Practice Address - Street 2:SUITE 18
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19114-2217
Practice Address - Country:US
Practice Address - Phone:215-671-9150
Practice Address - Fax:215-671-9160
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty