Basic Information
| Provider Information | |||||||||
| NPI: | 1891794103 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ANDREW H ZWICK MD LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5458 TOWN CENTER RD | ||||||||
| Address2: | SUITE 19 | ||||||||
| City: | BOCA RATON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334861089 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5613952424 | ||||||||
| FaxNumber: | 5613952709 | ||||||||
| Practice Location | |||||||||
| Address1: | 5458 TOWN CENTER RD | ||||||||
| Address2: | SUITE 19 | ||||||||
| City: | BOCA RATON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334861089 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5613952424 | ||||||||
| FaxNumber: | 5613952709 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/19/2005 | ||||||||
| LastUpdateDate: | 07/18/2008 | ||||||||
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| AuthorizedOfficialLastName: | ZWICK | ||||||||
| AuthorizedOfficialFirstName: | ANDREW | ||||||||
| AuthorizedOfficialMiddleName: | HARRISON | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5613952424 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | ME0065365 | FL | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | 5521288 | 01 | FL | AETNA PROV NUMBER | OTHER | 28433 | 01 | FL | BC/BS HEALTH OPTIONS NUMB | OTHER | 2983677-007 | 01 | FL | CIGNA PROVIDER NUMBER | OTHER | ME0065365 | 01 | FL | FL LICENSE NUMBER | OTHER |