Basic Information
| Provider Information | |||||||||
| NPI: | 1881650067 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | BROMEDICON INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 201 FLORAL VALE BLVD | ||||||||
| Address2: | |||||||||
| City: | YARDLEY | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190675524 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2158600100 | ||||||||
| FaxNumber: | 2158602703 | ||||||||
| Practice Location | |||||||||
| Address1: | 201 FLORAL VALE BLVD | ||||||||
| Address2: | |||||||||
| City: | YARDLEY | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190675524 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2158600100 | ||||||||
| FaxNumber: | 2158602703 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/25/2006 | ||||||||
| LastUpdateDate: | 12/10/2010 | ||||||||
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| AuthorizedOfficialLastName: | SZALABOFKA | ||||||||
| AuthorizedOfficialFirstName: | JENNIFER | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRACTICE ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 2158600100 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.