Basic Information
Provider Information | |||||||||
NPI: | 1013234467 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | SHROFF | ||||||||
FirstName: | SEEMA | ||||||||
MiddleName: | M | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.B.B.S., PHD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 12P GARDEN TER | ||||||||
Address2: |   | ||||||||
City: | NORTH ARLINGTON | ||||||||
State: | NJ | ||||||||
PostalCode: | 070318215 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2013496969 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 601 E ROLLINS ST | ||||||||
Address2: | DEPARTMENT OF PATHOLOGY | ||||||||
City: | ORLANDO | ||||||||
State: | FL | ||||||||
PostalCode: | 328031248 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4073039863 | ||||||||
FaxNumber: | 4073037252 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 04/26/2010 | ||||||||
LastUpdateDate: | 12/06/2017 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZP0102X | ME121711 | FL | N |   | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology | 207ZP0101X | ME121711 | FL | Y |   | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology |
ID Information
ID | Type | State | Issuer | Description | 014141300 | 05 | FL |   | MEDICAID |