Provider Demographics
NPI:1710924956
Name:CHILD NEUROLOGY LLC
Entity Type:Organization
Organization Name:CHILD NEUROLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER OF THE CHILD NEUROLOGY LLC
Authorized Official - Prefix:DR
Authorized Official - First Name:TATYANA
Authorized Official - Middle Name:
Authorized Official - Last Name:DUBROVSKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-961-2423
Mailing Address - Street 1:4440 SHERIDAN STREET
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021
Mailing Address - Country:US
Mailing Address - Phone:954-961-2423
Mailing Address - Fax:954-961-4860
Practice Address - Street 1:4440 SHERIDAN STREET
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021
Practice Address - Country:US
Practice Address - Phone:954-961-2423
Practice Address - Fax:954-961-4860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-31
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME709072084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child NeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL77841OtherBLUE CROSS BLUE SHIELD
FL276469500OtherPEDIATRIC ASSOCIATES PSN
FL276469500OtherFL NETPASS
FL276469500Medicaid