1417259540 NPI number — MICHELINO SCARLATA MD

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 1417259540 NPI number — MICHELINO SCARLATA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MICHELINO SCARLATA MD
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:
1417259540
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/06/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5161 COLLINS AVE
Provider Second Line Business Mailing Address:
APT 1609
Provider Business Mailing Address City Name:
MIAMI BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33140-2755
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
300-586-7191
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3801 BISCAYNE BLVD
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
MIAMI
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33137-9800
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-571-0620
Provider Business Practice Location Address Fax Number:
305-576-8099
Provider Enumeration Date:
11/22/2010

Additional Information

Authorized Official

Authorized Official Last Name:
SCARLATA
Authorized Official First Name:
MICHELINO
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
305-498-6377

Provider Taxonomy Codes

  • Taxonomy code: 2086X0206X , with the licence number:  ME104846 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208600000X , with the licence number: ME104846 , 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: 001349600 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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