Basic Information
| Provider Information | |||||||||
| NPI: | 1083338115 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FLORIDA POTOMAC HEALTH P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1177 HIGH RIDGE RD | ||||||||
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| City: | STAMFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 069051221 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1110 BRICKELL AVE STE 400 | ||||||||
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| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331313135 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8605587027 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/03/2022 | ||||||||
| LastUpdateDate: | 10/25/2022 | ||||||||
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| AuthorizedOfficialLastName: | KIMMEL | ||||||||
| AuthorizedOfficialFirstName: | JAY | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICIAN PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8607286740 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | POTOMAC HEALTH P.C. | ||||||||
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| NPICertificationDate: | 10/25/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.