Basic Information
Provider Information | |||||||||
NPI: | 1740266311 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | PADEH | ||||||||
FirstName: | YORAM | ||||||||
MiddleName: | CARMI | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 7800 S.W. 87TH AVENUE | ||||||||
Address2: | SUITE C-340 | ||||||||
City: | MIAMI | ||||||||
State: | FL | ||||||||
PostalCode: | 331733570 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3055957091 | ||||||||
FaxNumber: | 3055952836 | ||||||||
Practice Location | |||||||||
Address1: | 2925 AVENTURA BLVD | ||||||||
Address2: | SUITE 308 | ||||||||
City: | AVENTURA | ||||||||
State: | FL | ||||||||
PostalCode: | 331803124 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3059325662 | ||||||||
FaxNumber: | 3059321011 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 12/15/2005 | ||||||||
LastUpdateDate: | 10/01/2013 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207K00000X | ME82333 | FL | Y |   | Allopathic & Osteopathic Physicians | Allergy & Immunology |   | 207K00000X | 227893 | NY | N |   | Allopathic & Osteopathic Physicians | Allergy & Immunology |   |
ID Information
ID | Type | State | Issuer | Description | ME82333 | 01 | FL | FLORIDA MEDICAL LICENSE | OTHER | 272449900 | 05 | FL |   | MEDICAID | BP7333343 | 01 |   | DEA LICENSE | OTHER | 227893 | 01 | NY | NEW YORK MEDICAL LICENSE | OTHER |