Organization
PEDIATRIC HEMATOLOGY/ONCOLOGY SPECIALISTS, PSC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SALVATORE J BERTOLONE JR. MD (PRESIDENT)
(502) 629-7751
Entity
Organization
Contact information
Practice address
601 S FLOYD ST, SUITE 403, LOUISVILLE, KY 40202-1835
(502) 629-7751
(500) 629-5780
Mailing address
601 S FLOYD ST, SUITE 403, LOUISVILLE, KY 40202-1835
(502) 629-7751
(500) 629-5780
Taxonomy
Speciality
Code
Description
License number
State
103TC2200X
Clinical Child & Adolescent Psychologist
Primary
1505
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100096690
—
KY
Enumeration date
03/23/2010
Last updated
03/23/2010
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