Basic Information
| Provider Information | |||||||||
| NPI: | 1285932095 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MZ PROFESSIONAL SERVICES, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1065 NE 125TH ST | ||||||||
| Address2: | STE 409 | ||||||||
| City: | NORTH MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331615821 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8888526672 | ||||||||
| FaxNumber: | 3058914228 | ||||||||
| Practice Location | |||||||||
| Address1: | 7481 W. OAKLAND PARK BLVD. | ||||||||
| Address2: | STE 100 | ||||||||
| City: | LAUDERHILL | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333194985 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8888526672 | ||||||||
| FaxNumber: | 3058914228 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/02/2011 | ||||||||
| LastUpdateDate: | 11/11/2011 | ||||||||
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| AuthorizedOfficialLastName: | PUNJWANI | ||||||||
| AuthorizedOfficialFirstName: | SOHAIL | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO/PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7192855121 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0804X | ME54504 | FL | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Child & Adolescent Psychiatry | 2084P0800X | ME54504 | FL | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | EX561A | 01 | FL | MEDICARE PTAN FOR GROUP MZ PROFESSIONAL SERVICES, INC. | OTHER | 370943400 | 05 | FL | MEDICAID | 09837W | 01 | FL | MEDICARE PTAN INDIVIDUAL FOR MZ PROFESSIONAL SERVICES, INC | OTHER |