1659337517 NPI number — SOUTH COUNTY ENDOCRINOLOGY P A

Table of content: (NPI 1659337517)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659337517 NPI number — SOUTH COUNTY ENDOCRINOLOGY P A

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTH COUNTY ENDOCRINOLOGY P A
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:
Provider Other Organization Name Type Code:
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:
1659337517
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
670 GLADES RD
Provider Second Line Business Mailing Address:
SUITE 310
Provider Business Mailing Address City Name:
BOCA RATON
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33431-6461
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-367-8202
Provider Business Mailing Address Fax Number:
561-367-8257

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
670 GLADES RD
Provider Second Line Business Practice Location Address:
SUITE 310
Provider Business Practice Location Address City Name:
BOCA RATON
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33431-6461
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-367-8202
Provider Business Practice Location Address Fax Number:
561-367-8257
Provider Enumeration Date:
04/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KELIJMAN
Authorized Official First Name:
MIRTHA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
561-367-8202

Provider Taxonomy Codes

  • Taxonomy code: 207RE0101X , with the licence number:  ME 67985 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 252927 . This is a "AVMED" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 44842 . This is a "BLUE CROSS BLUE SHIELD OF FLA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: P00064212 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: FP0935 . This is a "HEALTHNET" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com