1427394790 NPI number — MR. EDUARDO THEODORE AVERSANO ACUPINCTURIST

Table of content: MR. EDUARDO THEODORE AVERSANO ACUPINCTURIST (NPI 1427394790)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427394790 NPI number — MR. EDUARDO THEODORE AVERSANO ACUPINCTURIST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AVERSANO
Provider First Name:
EDUARDO
Provider Middle Name:
THEODORE
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
ACUPINCTURIST
Provider Gender Code:
M

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:
1427394790
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/18/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7301 W PALMETTO PARK RD
Provider Second Line Business Mailing Address:
STE 103C
Provider Business Mailing Address City Name:
BOCA RATON
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33433-3455
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-395-2667
Provider Business Mailing Address Fax Number:
561-395-2685

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7301 W PALMETTO PARK RD
Provider Second Line Business Practice Location Address:
STE 103C
Provider Business Practice Location Address City Name:
BOCA RATON
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33433-3455
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-395-2667
Provider Business Practice Location Address Fax Number:
561-395-2685
Provider Enumeration Date:
12/14/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 171100000X , with the licence number:  000366-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 102853000 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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