1740502228 NPI number — CLEOPATRA GORDON PUSEY, MD P.A.

Table of content: (NPI 1740502228)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740502228 NPI number — CLEOPATRA GORDON PUSEY, MD P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CLEOPATRA GORDON PUSEY, MD 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:
LIFE IS BEAUTIFUL, MD
Provider Other Organization Name Type Code:
3
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:
1740502228
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/28/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
222 S FLAMINGO RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PEMBROKE PINES
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33027-1721
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-392-9026
Provider Business Mailing Address Fax Number:
954-357-2353

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
700 N HIATUS RD
Provider Second Line Business Practice Location Address:
SUITE 213
Provider Business Practice Location Address City Name:
PEMBROKE PINES
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33026-5206
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-392-9026
Provider Business Practice Location Address Fax Number:
954-357-2353
Provider Enumeration Date:
02/24/2010

Additional Information

Authorized Official

Authorized Official Last Name:
GORDON PUSEY
Authorized Official First Name:
CLEOPATRA
Authorized Official Middle Name:
TAMARIA
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
954-392-9026

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , 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: 146LM . This is a "BCBS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 281390401 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 281390402 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 281390400 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 311776 . This is a "AVMED" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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