Basic Information
| Provider Information | |||||||||
| NPI: | 1659309698 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NORTH BROWARD HOSPITAL DISTRICT | ||||||||
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| OtherOrganizationName: | PEDIATRIC ENDOCRINOLOGY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 862851 | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328862851 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9548474273 | ||||||||
| FaxNumber: | 9548474245 | ||||||||
| Practice Location | |||||||||
| Address1: | 1625 SE 3 AVENUE | ||||||||
| Address2: | SUTIE 635 | ||||||||
| City: | FORT LAUDERDALE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33316 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9547642801 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2006 | ||||||||
| LastUpdateDate: | 09/12/2007 | ||||||||
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| AuthorizedOfficialLastName: | NASK | ||||||||
| AuthorizedOfficialFirstName: | FRANK | ||||||||
| AuthorizedOfficialMiddleName: | P | ||||||||
| AuthorizedOfficialTitleorPosition: | SR VICE PRESIDENT CFO | ||||||||
| AuthorizedOfficialTelephone: | 9543555064 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | NORTH BROWARD HOSPITAL DISTRICT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics | 207RE0101X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism |
ID Information
| ID | Type | State | Issuer | Description | 00020 | 01 | FL | BCBS | OTHER |