1235686783 NPI number — ICAN BENEFIT GROUP

Table of content: (NPI 1235686783)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235686783 NPI number — ICAN BENEFIT GROUP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ICAN BENEFIT GROUP
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:
1235686783
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/01/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5300 BROKEN SOUND BLVD
Provider Second Line Business Mailing Address:
200
Provider Business Mailing Address City Name:
BOCA RATON
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33487-3520
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2251 NORTH FEDERAL HIGHWAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
POMPANO BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33062
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
180-034-4609
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/01/2016

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SABOTKA
Authorized Official First Name:
DEAN
Authorized Official Middle Name:
Authorized Official Title or Position:
AGENT
Authorized Official Telephone Number:
954-588-7196

Provider Taxonomy Codes

  • Taxonomy code: 251X00000X , 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)