1417132176 NPI number — PETER D. SARBONE, M.D., P.A.

Table of content: (NPI 1417132176)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417132176 NPI number — PETER D. SARBONE, M.D., P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PETER D. SARBONE, 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:
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:
1417132176
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/31/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5601 N. DIXIE HIGHWAY
Provider Second Line Business Mailing Address:
SUITE #401
Provider Business Mailing Address City Name:
FORT LAUDERDALE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33334
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-491-4304
Provider Business Mailing Address Fax Number:
954-491-4350

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5601 N DIXIE HWY
Provider Second Line Business Practice Location Address:
SUITE #401
Provider Business Practice Location Address City Name:
OAKLAND PARK
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33334-4148
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-491-4304
Provider Business Practice Location Address Fax Number:
954-491-4350
Provider Enumeration Date:
12/31/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SARBONE
Authorized Official First Name:
PETER
Authorized Official Middle Name:
D
Authorized Official Title or Position:
OWNER/PRESIDENT
Authorized Official Telephone Number:
954-491-4304

Provider Taxonomy Codes

  • Taxonomy code: 207N00000X , with the licence number:  ME39384 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207NS0135X , with the licence number: ME39384 , 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)