1861574030 NPI number — PEDIATRIC PARTNERS OF PALM BEACH COUNTY

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 1861574030 NPI number — PEDIATRIC PARTNERS OF PALM BEACH COUNTY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PEDIATRIC PARTNERS OF PALM BEACH COUNTY
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:
1861574030
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/28/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3401 PGA BLVD
Provider Second Line Business Mailing Address:
SUITE #300
Provider Business Mailing Address City Name:
PALM BEACH GARDENS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33410-2823
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-745-4222
Provider Business Mailing Address Fax Number:
561-627-0040

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3401 PGA BLVD
Provider Second Line Business Practice Location Address:
SUITE #300
Provider Business Practice Location Address City Name:
PALM BEACH GARDENS
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33410-2823
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-745-4222
Provider Business Practice Location Address Fax Number:
561-627-0040
Provider Enumeration Date:
10/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SCHECHTMAN
Authorized Official First Name:
TOMMY
Authorized Official Middle Name:
JAY
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
561-745-4222

Provider Taxonomy Codes

  • Taxonomy code: 208000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 254459800 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com