1184075269 NPI number — BRIAN C LEUNG MD-CENTRAL FLORIDA BONE AND JOINT INSTITUTE, PLLC

Table of content: (NPI 1184075269)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184075269 NPI number — BRIAN C LEUNG MD-CENTRAL FLORIDA BONE AND JOINT INSTITUTE, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BRIAN C LEUNG MD-CENTRAL FLORIDA BONE AND JOINT INSTITUTE, PLLC
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:
CENTRAL FLORIDA BONE AND JOINT INSTITUTE
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:
1184075269
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/15/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2745 REBECCA LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ORANGE CITY
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32763-8333
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
386-775-2012
Provider Business Mailing Address Fax Number:
386-775-2013

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2745 REBECCA LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ORANGE CITY
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32763-8333
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
386-775-2012
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/29/2016

Additional Information

Authorized Official

Authorized Official Last Name:
LEUNG
Authorized Official First Name:
BRIAN
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
386-775-2012

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207XS0106X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207XX0005X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 213ES0103X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 018370800 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com