Provider Demographics
NPI:1811932932
Name:DIAGNOSTIC BREAST CENTER
Entity type:Organization
Organization Name:DIAGNOSTIC BREAST CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:KUBEK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-356-9030
Mailing Address - Street 1:3475 W CHESTER PIKE
Mailing Address - Street 2:STE 240
Mailing Address - City:NEWTOWN SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19073-4280
Mailing Address - Country:US
Mailing Address - Phone:610-356-9030
Mailing Address - Fax:610-356-9036
Practice Address - Street 1:3475 W CHESTER PIKE
Practice Address - Street 2:STE 240
Practice Address - City:NEWTOWN SQUARE
Practice Address - State:PA
Practice Address - Zip Code:19073-4280
Practice Address - Country:US
Practice Address - Phone:610-356-9030
Practice Address - Fax:610-356-9036
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA154161261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center