Organization
CHILD NEUROLOGY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TATYANA DUBROVSKY MD (MANAGER OF THE CHILD NEUROLOGY LLC)
(954) 961-2423
Entity
Organization
Contact information
Practice address
4440 SHERIDAN STREET, HOLLYWOOD, FL 33021
(954) 961-2423
(954) 961-4860
Mailing address
4440 SHERIDAN STREET, HOLLYWOOD, FL 33021
(954) 961-2423
(954) 961-4860
Taxonomy
Speciality
Code
Description
License number
State
2084N0402X
Neurology with Special Qualifications in Child Neurology Physician
Primary
ME70907
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
276469500
PEDIATRIC ASSOCIATES PSN
FL
05
—
276469500
—
FL
01
—
77841
BLUE CROSS BLUE SHIELD
FL
Enumeration date
05/31/2006
Last updated
05/16/2008
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