1619100070 NPI number — INFECTIOUS DISEASE OF GREATER ORLANDO PLC

Table of content: (NPI 1619100070)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619100070 NPI number — INFECTIOUS DISEASE OF GREATER ORLANDO PLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INFECTIOUS DISEASE OF GREATER ORLANDO PLC
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:
1619100070
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/21/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 950789
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAKE MARY
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32795-0789
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-878-7640
Provider Business Mailing Address Fax Number:
407-878-7651

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
142 PARLIAMENT LOOP
Provider Second Line Business Practice Location Address:
STE# 1018
Provider Business Practice Location Address City Name:
LAKE MARY
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32746-3562
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-878-7640
Provider Business Practice Location Address Fax Number:
407-878-7651
Provider Enumeration Date:
09/01/2009

Additional Information

Authorized Official

Authorized Official Last Name:
HAMID
Authorized Official First Name:
NAVEED
Authorized Official Middle Name:
SYED
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
407-878-7640

Provider Taxonomy Codes

  • Taxonomy code: 207RI0200X , with the licence number:  ME97394 , 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)





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