1386817096 NPI number — ADAM S PERLMAN OD PA

Table of content: (NPI 1770752347)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386817096 NPI number — ADAM S PERLMAN OD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADAM S PERLMAN OD PA
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:
1386817096
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/29/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3001 NE 185TH ST
Provider Second Line Business Mailing Address:
#337
Provider Business Mailing Address City Name:
AVENTURA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33180-3347
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-695-6617
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
483 E 49TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HIALEAH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33013-1867
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-403-7312
Provider Business Practice Location Address Fax Number:
305-456-2703
Provider Enumeration Date:
04/03/2008

Additional Information

Authorized Official

Authorized Official Last Name:
PERLMAN
Authorized Official First Name:
ADAM
Authorized Official Middle Name:
S
Authorized Official Title or Position:
OPTOMETRIST SOLE PROVIDER
Authorized Official Telephone Number:
954-695-6617

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  OPC4049 , 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: 001391700 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com