1972687556 NPI number — ASTHMA & ALLERGY ASSOCIATES OF FL PA

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 1972687556 NPI number — ASTHMA & ALLERGY ASSOCIATES OF FL PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ASTHMA & ALLERGY ASSOCIATES OF FL PA
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:
1972687556
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/07/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7800 SW 87TH AVE
Provider Second Line Business Mailing Address:
C-340
Provider Business Mailing Address City Name:
MIAMI
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33173-3570
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-595-0109
Provider Business Mailing Address Fax Number:
305-595-2836

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7800 SW 87TH AVE
Provider Second Line Business Practice Location Address:
C-340
Provider Business Practice Location Address City Name:
MIAMI
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33173-3570
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-595-0109
Provider Business Practice Location Address Fax Number:
305-595-7092
Provider Enumeration Date:
10/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MONTES
Authorized Official First Name:
PATRICIA
Authorized Official Middle Name:
Authorized Official Title or Position:
CREDENTIALING MANAGER
Authorized Official Telephone Number:
305-595-0109

Provider Taxonomy Codes

  • Taxonomy code: 207K00000X , with the licence number:  ME0046002 , 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: 253284100 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: ME0046002 . This is a "MEDICAL LICENSE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 043092702 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: ME0039515 . This is a "MEDICAL LICENSE DR. UBALS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: ME0071552 . This is a "M L - DR. GERSHMAN" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: ME88114 . This is a "MED. LIC. DR. MARK" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 049010500 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 251869400 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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