1427595354 NPI number — E-LAB OF FLORIDA INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427595354 NPI number — E-LAB OF FLORIDA INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
E-LAB OF FLORIDA 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:
1427595354
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/01/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6100 HOLLYWOOD BLVD
Provider Second Line Business Mailing Address:
SUITE 306
Provider Business Mailing Address City Name:
HOLLYWOOD
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33024-7982
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-530-8332
Provider Business Mailing Address Fax Number:
954-533-7605

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6100 HOLLYWOOD BLVD
Provider Second Line Business Practice Location Address:
SUITE 306
Provider Business Practice Location Address City Name:
HOLLYWOOD
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33024-7982
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-530-8332
Provider Business Practice Location Address Fax Number:
954-533-7605
Provider Enumeration Date:
01/30/2017

Additional Information

Authorized Official

Authorized Official Last Name:
KAMRA
Authorized Official First Name:
AMIT
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
215-435-4773

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 115413200 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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