Provider Demographics
NPI:1366673170
Name:ASSOCIATED MEDICAL SPECIALTIES, INC.
Entity Type:Organization
Organization Name:ASSOCIATED MEDICAL SPECIALTIES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:I
Authorized Official - Last Name:BALABAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-677-4486
Mailing Address - Street 1:2901 SOUTHAMPTON RD
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19154-1208
Mailing Address - Country:US
Mailing Address - Phone:215-677-4486
Mailing Address - Fax:215-677-3644
Practice Address - Street 1:8848 FRANKFORD AVE
Practice Address - Street 2:
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19136-1313
Practice Address - Country:US
Practice Address - Phone:215-331-1819
Practice Address - Fax:215-331-3402
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ASSOCIATED MEDICAL SPECIALTIES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-07-29
Last Update Date:2011-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
0188120003Medicare NSC