1912965666 NPI number — JOHN R DYLEWSKI M D P A

Table of content: (NPI 1912965666)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912965666 NPI number — JOHN R DYLEWSKI M D P A

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JOHN R DYLEWSKI 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:
1912965666
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/01/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6476 SW 118TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIAMI
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33156-4800
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-796-6082
Provider Business Mailing Address Fax Number:
305-663-0236

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6705 RED ROAD
Provider Second Line Business Practice Location Address:
SUITE 500
Provider Business Practice Location Address City Name:
CORAL GABLES
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33143
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-662-2530
Provider Business Practice Location Address Fax Number:
305-662-2375
Provider Enumeration Date:
05/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DYLEWSKI
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
RICHARD
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
305-796-6082

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  ME0063942 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RC0001X , with the licence number: ME0063942 , 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: 269705000 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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