1568610244 NPI number — FLAVIA VAN RIEL MD PA

Table of content: (NPI 1568610244)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568610244 NPI number — FLAVIA VAN RIEL MD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FLAVIA VAN RIEL MD 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:
1568610244
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/29/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4315 ALTON RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIAMI BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33140-2850
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-401-8899
Provider Business Mailing Address Fax Number:
305-721-1692

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
975 ARTHUR GODFREY RD
Provider Second Line Business Practice Location Address:
SUITE 301
Provider Business Practice Location Address City Name:
MIAMI BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33140-3329
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-401-8899
Provider Business Practice Location Address Fax Number:
305-721-1692
Provider Enumeration Date:
09/05/2008

Additional Information

Authorized Official

Authorized Official Last Name:
VAN RIEL
Authorized Official First Name:
FLAVIA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
305-401-8899

Provider Taxonomy Codes

  • Taxonomy code: 261QM0850X , with the licence number:  ME 86943 , 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: 275039200 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: AN265 . This is a "MEDICARE PART B GROUP" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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