Provider Demographics
NPI:1386048197
Name:PREVENTION CENTER LLC
Entity type:Organization
Organization Name:PREVENTION CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:LEON
Authorized Official - Middle Name:GREGORY
Authorized Official - Last Name:DE MASI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-353-5840
Mailing Address - Street 1:1999 SPROUL RD
Mailing Address - Street 2:SUITE 21
Mailing Address - City:BROOMALL
Mailing Address - State:PA
Mailing Address - Zip Code:19008-3508
Mailing Address - Country:US
Mailing Address - Phone:610-353-5840
Mailing Address - Fax:610-353-3420
Practice Address - Street 1:1999 SPROUL RD
Practice Address - Street 2:SUITE 21
Practice Address - City:BROOMALL
Practice Address - State:PA
Practice Address - Zip Code:19008-3508
Practice Address - Country:US
Practice Address - Phone:610-353-5840
Practice Address - Fax:610-353-3420
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-22
Last Update Date:2014-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD025728E2083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive MedicineGroup - Single Specialty