1609806025 NPI number — DR. TED HARB MD

Table of content: DR. TED HARB MD (NPI 1609806025)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609806025 NPI number — DR. TED HARB MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HARB
Provider First Name:
TED
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SAMIA-HARB
Provider Other First Name:
LABA RAMEZ
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1609806025
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/15/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3848 F.A.U. BLVD SUITE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOCA RATON
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33431-6437
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-826-1134
Provider Business Mailing Address Fax Number:
561-826-1134

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3848 FAU BLVD STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOCA RATON
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33431-6437
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-362-9191
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/03/2006

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: 2085R0202X , with the licence number:  4301076029 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: P00256904 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 4787546 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4878555 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 117023700 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com