1306026604 NPI number — PSYCHOLOGICAL ASSOCIATES OF THE PALM BEACHES INC

Table of content: DR. SONGHUI MARTIN RN, PA (NPI 1720813587)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306026604 NPI number — PSYCHOLOGICAL ASSOCIATES OF THE PALM BEACHES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PSYCHOLOGICAL ASSOCIATES OF THE PALM BEACHES INC
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:
1306026604
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/07/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3692 MOON BAY CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WELLINGTON
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33414-8806
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-279-9295
Provider Business Mailing Address Fax Number:
561-333-8029

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1300 NW 17TH AVE STE 101
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DELRAY BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33445-2554
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-279-9295
Provider Business Practice Location Address Fax Number:
561-333-8029
Provider Enumeration Date:
11/05/2007

Additional Information

Authorized Official

Authorized Official Last Name:
COSTANZA
Authorized Official First Name:
SCOTT
Authorized Official Middle Name:
MICHAEL
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
561-279-9295

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  PY5739 , 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)





Copyright © 2007-2025 www.npivalidator.com