1013110790 NPI number — MARGATE PEDIATRICS PA

Table of content: (NPI 1013110790)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013110790 NPI number — MARGATE PEDIATRICS PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARGATE PEDIATRICS PA
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:
1013110790
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/05/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5100 WEST COPANS ROAD
Provider Second Line Business Mailing Address:
SUITE 800
Provider Business Mailing Address City Name:
MARGATE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33063
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-975-4611
Provider Business Mailing Address Fax Number:
954-975-4079

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5100 WEST COPANS ROAD
Provider Second Line Business Practice Location Address:
SUITE 800
Provider Business Practice Location Address City Name:
MARGATE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33063
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-975-4611
Provider Business Practice Location Address Fax Number:
954-975-4079
Provider Enumeration Date:
06/08/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ASAD
Authorized Official First Name:
ALIYA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
954-975-4611

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  ME83289 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208000000X , with the licence number: ME83289 ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1417947854 . This is a "PERSONAL NPI #" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 265466100 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: ME83289 . This is a "STATE MEDICAL LICENSE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 115027300 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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