1770546210 NPI number — MR. NORMAN PALGON M.D.

Table of content: MR. NORMAN PALGON M.D. (NPI 1770546210)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770546210 NPI number — MR. NORMAN PALGON M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PALGON
Provider First Name:
NORMAN
Provider Middle Name:
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

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:
1770546210
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/11/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
410 EAST HALLANDALE BEACH BLVD
Provider Second Line Business Mailing Address:
CHEN MEDICAL HALLANDALE, INC
Provider Business Mailing Address City Name:
HALLANDALE BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33009-5584
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-454-5777
Provider Business Mailing Address Fax Number:
954-924-0812

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2230 NW 95TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIAMI
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33147-2414
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-454-5777
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RH0003X , with the licence number:  ME0041906 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: ME41906 , 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: 067833500 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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