Basic Information
Provider Information | |||||||||
NPI: | 1922079185 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | AYUB SOKOL MATZKOWITZ SENNABAUM MDS PA | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | DBA NEW HOPE CANCER CENTER | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 7651 MEDICAL DR | ||||||||
Address2: |   | ||||||||
City: | HUDSON | ||||||||
State: | FL | ||||||||
PostalCode: | 34667 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7278689208 | ||||||||
FaxNumber: | 7278686420 | ||||||||
Practice Location | |||||||||
Address1: | 7651 MEDICAL DR | ||||||||
Address2: |   | ||||||||
City: | HUDSON | ||||||||
State: | FL | ||||||||
PostalCode: | 346676594 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7276869208 | ||||||||
FaxNumber: | 7278686420 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 01/27/2006 | ||||||||
LastUpdateDate: | 08/18/2008 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: | 03/27/2008 | ||||||||
NPIReactivationDate: | 08/18/2008 | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | AYUB | ||||||||
AuthorizedOfficialFirstName: | JORGE | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | V PRESIDENT | ||||||||
AuthorizedOfficialTelephone: | 7278689208 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: | MD | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0001X |   | FL | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology | 207RH0003X |   | FL | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
No ID Information.