Organization
LIBERTY EYE SURGICAL CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DENNIS SLOCHOWER M.D. (MEDICAL DIRECTOR)
(215) 673-9231
Entity
Organization
Contact information
Practice address
9122 BLUE GRASS RD, PHILADELPHIA, PA 19114-3202
(215) 673-9231
(215) 673-9236
Mailing address
9122 BLUE GRASS RD, PHILADELPHIA, PA 19114-3202
(215) 673-9231
(215) 673-9236
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
17401501
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0001624000
KEYSTONE HMO
PA
05
—
100964206001
—
PA
05
—
30019554
—
PA
05
—
35387
—
PA
01
—
3562638
AETNA HEALTHCARE
PA
Enumeration date
05/02/2006
Last updated
12/09/2010
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