Basic Information
Provider Information | |||||||||
NPI: | 1477525673 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | FASS | ||||||||
FirstName: | PAUL | ||||||||
MiddleName: | T | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 729 | ||||||||
Address2: |   | ||||||||
City: | HALLANDALE | ||||||||
State: | FL | ||||||||
PostalCode: | 330080729 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3055036320 | ||||||||
FaxNumber: | 3055036329 | ||||||||
Practice Location | |||||||||
Address1: | 2999 NE 191ST ST | ||||||||
Address2: | SUITE 230 | ||||||||
City: | AVENTURA | ||||||||
State: | FL | ||||||||
PostalCode: | 331803123 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3059339953 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 02/02/2006 | ||||||||
LastUpdateDate: | 09/17/2007 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207KA0200X | ME15036 | FL | Y |   | Allopathic & Osteopathic Physicians | Allergy & Immunology | Allergy |
No ID Information.