Basic Information
| Provider Information | |||||||||
| NPI: | 1265822340 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JORDAN FABRIKANT, D.O., P.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6140 SW 70TH ST | ||||||||
| Address2: | SECOND FLOOR | ||||||||
| City: | SOUTH MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331433419 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3052847577 | ||||||||
| FaxNumber: | 3056753714 | ||||||||
| Practice Location | |||||||||
| Address1: | 6140 SW 70TH ST | ||||||||
| Address2: | SECOND FLOOR | ||||||||
| City: | SOUTH MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331433419 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3052847577 | ||||||||
| FaxNumber: | 3056753714 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/28/2015 | ||||||||
| LastUpdateDate: | 01/28/2015 | ||||||||
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| AuthorizedOfficialLastName: | FABRIKANT | ||||||||
| AuthorizedOfficialFirstName: | JORDAN | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3052847742 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | D.O | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207N00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Dermatology |
No ID Information.