1346504990 NPI number — ADAGIO MEDICAL LLC

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 1346504990 NPI number — ADAGIO MEDICAL LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADAGIO MEDICAL LLC
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:
1346504990
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/28/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
19101 MYSTIC POINTE DR
Provider Second Line Business Mailing Address:
SUIT 2604
Provider Business Mailing Address City Name:
AVENTURA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33180-4512
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
908-347-3131
Provider Business Mailing Address Fax Number:
786-284-8459

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4302 ALTON RD
Provider Second Line Business Practice Location Address:
SUIT 105
Provider Business Practice Location Address City Name:
MIAMI BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33140-2891
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
786-463-1786
Provider Business Practice Location Address Fax Number:
786-284-8459
Provider Enumeration Date:
06/28/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
VELASCO
Authorized Official First Name:
MARJORIE
Authorized Official Middle Name:
Authorized Official Title or Position:
MEDICAL ASSISTAN
Authorized Official Telephone Number:
908-377-4682

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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