1629055256 NPI number — DR. SAMUEL NEAL CANTOR D.P.M.

Table of content: DR. SAMUEL NEAL CANTOR D.P.M. (NPI 1629055256)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629055256 NPI number — DR. SAMUEL NEAL CANTOR D.P.M.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CANTOR
Provider First Name:
SAMUEL
Provider Middle Name:
NEAL
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.P.M.
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:
1629055256
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/08/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8200 NW 27 ST
Provider Second Line Business Mailing Address:
STE 108
Provider Business Mailing Address City Name:
DORAL
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33122-1906
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
786-662-3893
Provider Business Mailing Address Fax Number:
786-662-3899

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
601 N FLAMINGO RD
Provider Second Line Business Practice Location Address:
SUITE 403
Provider Business Practice Location Address City Name:
PEMBROKE PINES
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33028-1012
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-443-5757
Provider Business Practice Location Address Fax Number:
954-374-8883
Provider Enumeration Date:
12/23/2005

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: 213ES0103X , with the licence number:  PO1051 , 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: PO-1051 . This is a "STATE LICENSE NUMBER" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 041286400 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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