1215924394 NPI number — CRAIG MITCHELL SENZON M.D.

Table of content: CRAIG MITCHELL SENZON M.D. (NPI 1215924394)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215924394 NPI number — CRAIG MITCHELL SENZON M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SENZON
Provider First Name:
CRAIG
Provider Middle Name:
MITCHELL
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

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:
1215924394
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/24/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9960 NW 116TH WAY
Provider Second Line Business Mailing Address:
SUITE 13
Provider Business Mailing Address City Name:
MEDLEY
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33178-1167
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
786-924-1311
Provider Business Mailing Address Fax Number:
786-924-1313

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9100 BELVEDERE RD
Provider Second Line Business Practice Location Address:
SUITE 109
Provider Business Practice Location Address City Name:
ROYAL PALM BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33411-3607
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-249-7575
Provider Business Practice Location Address Fax Number:
561-249-7576
Provider Enumeration Date:
10/04/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084N0400X , with the licence number:  2111711 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084N0400X , with the licence number: ME90505 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084N0400X , with the licence number: 226253 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084N0400X , with the licence number: 0420010990 , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084N0400X , with the licence number: ME104508 , 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: 2109166 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1011660 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".




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