1821284316 NPI number — PALM BEACH PODIATRIC CENTER

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 1821284316 NPI number — PALM BEACH PODIATRIC CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PALM BEACH PODIATRIC CENTER
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:
1821284316
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/07/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10115 W FOREST HILL BLVD
Provider Second Line Business Mailing Address:
SUITE 302
Provider Business Mailing Address City Name:
WELLINGTON
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33414-3105
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-641-7884
Provider Business Mailing Address Fax Number:
561-641-0440

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10115 W FOREST HILL BLVD
Provider Second Line Business Practice Location Address:
SUITE 302
Provider Business Practice Location Address City Name:
WELLINGTON
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33414-3105
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-641-7884
Provider Business Practice Location Address Fax Number:
561-641-0440
Provider Enumeration Date:
09/19/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
LERNER
Authorized Official First Name:
JEFFREY
Authorized Official Middle Name:
CARL
Authorized Official Title or Position:
DOCTOR
Authorized Official Telephone Number:
561-641-7884

Provider Taxonomy Codes

  • Taxonomy code: 213ES0103X , with the licence number:  PL1852 , 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: DG1880 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".