Provider Demographics
NPI:1962803031
Name:SUBURBAN MULTISPECIALTY LIMITED, LLC
Entity type:Organization
Organization Name:SUBURBAN MULTISPECIALTY LIMITED, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DINA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:DUBROW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-667-4080
Mailing Address - Street 1:1 BELMONT AVENUE
Mailing Address - Street 2:SUITE 416
Mailing Address - City:BALA CYNWYD
Mailing Address - State:PA
Mailing Address - Zip Code:19004-1607
Mailing Address - Country:US
Mailing Address - Phone:610-667-4080
Mailing Address - Fax:610-667-2748
Practice Address - Street 1:1 BELMONT AVENUE
Practice Address - Street 2:SUITE 416
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004-1607
Practice Address - Country:US
Practice Address - Phone:610-667-4080
Practice Address - Fax:610-667-2748
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-09
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS.015962207YS0123X
PAOS-009268L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic SurgeryGroup - Multi-Specialty