Organization
CHILD NEUROLOGY LLC
Active
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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