1780900159 NPI number — NELSON PRESCHEL., M.D., P.A.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780900159 NPI number — NELSON PRESCHEL., M.D., P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NELSON PRESCHEL., M.D., P.A.
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:
6
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:
1780900159
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/02/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
17900 NW 5TH ST STE 204
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PEMBROKE PINES
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33029-2809
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-222-7082
Provider Business Mailing Address Fax Number:
305-515-5606

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17900 NW 5TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PEMBROKE PINES
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33029-2808
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-222-7082
Provider Business Practice Location Address Fax Number:
305-515-5606
Provider Enumeration Date:
04/10/2010

Additional Information

Authorized Official

Authorized Official Last Name:
PRESCHEL
Authorized Official First Name:
NELSON
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
786-457-3792

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  ME82083 , 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: 017106000 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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