1477761179 NPI number — SALTZMAN, TANIS, PITTELL, LEVIN AND JACOBSON, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477761179 NPI number — SALTZMAN, TANIS, PITTELL, LEVIN AND JACOBSON, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SALTZMAN, TANIS, PITTELL, LEVIN AND JACOBSON, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
PEDIATRIC ASSOCIATES
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1477761179
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/23/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
900 S PINE ISLAND RD
Provider Second Line Business Mailing Address:
SUITE 800
Provider Business Mailing Address City Name:
PLANTATION
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33324-3920
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-821-8611
Provider Business Mailing Address Fax Number:
305-827-1753

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15507-15 NW 67TH AVE
Provider Second Line Business Practice Location Address:
301
Provider Business Practice Location Address City Name:
MIAMI
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33014
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-821-8611
Provider Business Practice Location Address Fax Number:
305-827-1753
Provider Enumeration Date:
05/18/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CORSIATTO
Authorized Official First Name:
PATRICIA
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
954-967-6400

Provider Taxonomy Codes

  • Taxonomy code: 208000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 373797711 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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