1285932095 NPI number — MZ PROFESSIONAL SERVICES, INC.

Table of content: (NPI 1285932095)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285932095 NPI number — MZ PROFESSIONAL SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MZ PROFESSIONAL SERVICES, INC.
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:
1285932095
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/11/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1065 NE 125TH ST
Provider Second Line Business Mailing Address:
STE 409
Provider Business Mailing Address City Name:
NORTH MIAMI
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33161-5821
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
888-852-6672
Provider Business Mailing Address Fax Number:
305-891-4228

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7481 W. OAKLAND PARK BLVD.
Provider Second Line Business Practice Location Address:
STE 100
Provider Business Practice Location Address City Name:
LAUDERHILL
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33319-4985
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
888-852-6672
Provider Business Practice Location Address Fax Number:
305-891-4228
Provider Enumeration Date:
03/02/2011

Additional Information

Authorized Official

Authorized Official Last Name:
PUNJWANI
Authorized Official First Name:
SOHAIL
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO/PRESIDENT
Authorized Official Telephone Number:
719-285-5121

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  ME54504 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2084P0804X , with the licence number: ME54504 , 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: EX561A . This is a "MEDICARE PTAN FOR GROUP MZ PROFESSIONAL SERVICES, INC." identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 370943400 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 09837W . This is a "MEDICARE PTAN INDIVIDUAL FOR MZ PROFESSIONAL SERVICES, INC" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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