1093808289 NPI number — ACKERMAN & PLISKOW M.D. P.A.

Table of content: (NPI 1093808289)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093808289 NPI number — ACKERMAN & PLISKOW M.D. P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ACKERMAN & PLISKOW M.D. 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:
ADVANCED WOMENS HEALTHCARE
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:
1093808289
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/19/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
603 VILLAGE BLVD.
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
WEST PALM BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33409
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-683-1331
Provider Business Mailing Address Fax Number:
561-683-4615

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
603 VILLAGE BLVD.
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
WEST PALM BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33409
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-683-1331
Provider Business Practice Location Address Fax Number:
561-683-4615
Provider Enumeration Date:
10/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PLISKOW
Authorized Official First Name:
STEVEN
Authorized Official Middle Name:
Authorized Official Title or Position:
DOCTOR
Authorized Official Telephone Number:
561-683-1331

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  ME0054211 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207V00000X , with the licence number: OS8387 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207V00000X , with the licence number: ME0043294 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 370054200 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 370057700 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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