1568415693 NPI number — SOUTH BEACH PREVENTIVE CARDIOLOGY PA

Table of content: (NPI 1568415693)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568415693 NPI number — SOUTH BEACH PREVENTIVE CARDIOLOGY PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTH BEACH PREVENTIVE CARDIOLOGY PA
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:
1568415693
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/13/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1691 MICHIGAN AVE
Provider Second Line Business Mailing Address:
SUITE 500
Provider Business Mailing Address City Name:
MIAMI BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33139-2520
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-538-3828
Provider Business Mailing Address Fax Number:
305-538-1979

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1691 MICHIGAN AVE
Provider Second Line Business Practice Location Address:
SUITE 500
Provider Business Practice Location Address City Name:
MIAMI BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33139-2520
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-538-3828
Provider Business Practice Location Address Fax Number:
305-538-1979
Provider Enumeration Date:
05/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
AGATSTON
Authorized Official First Name:
ARTHUR
Authorized Official Middle Name:
S
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
305-538-3828

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  OS5077 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RC0000X , with the licence number: ME34856 , 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