Provider Demographics
NPI:1720259583
Name:SPECIALTY MANAGEMENT
Entity Type:Organization
Organization Name:SPECIALTY MANAGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:SOPHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:AVANZATO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:484-432-2737
Mailing Address - Street 1:626 SNYDER AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19148-2419
Mailing Address - Country:US
Mailing Address - Phone:267-940-0300
Mailing Address - Fax:
Practice Address - Street 1:626 SNYDER AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19148-2419
Practice Address - Country:US
Practice Address - Phone:267-940-0300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-19
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty