Basic Information
Provider Information | |||||||||
NPI: | 1972687556 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | ASTHMA & ALLERGY ASSOCIATES OF FL PA | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 7800 SW 87TH AVE | ||||||||
Address2: | C-340 | ||||||||
City: | MIAMI | ||||||||
State: | FL | ||||||||
PostalCode: | 331733570 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3055950109 | ||||||||
FaxNumber: | 3055952836 | ||||||||
Practice Location | |||||||||
Address1: | 7800 SW 87TH AVE | ||||||||
Address2: | C-340 | ||||||||
City: | MIAMI | ||||||||
State: | FL | ||||||||
PostalCode: | 331733570 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3055950109 | ||||||||
FaxNumber: | 3055957092 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 10/24/2006 | ||||||||
LastUpdateDate: | 12/07/2017 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | MONTES | ||||||||
AuthorizedOfficialFirstName: | PATRICIA | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | CREDENTIALING MANAGER | ||||||||
AuthorizedOfficialTelephone: | 3055950109 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207K00000X | ME0046002 | FL | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Allergy & Immunology |   |
ID Information
ID | Type | State | Issuer | Description | 253284100 | 05 | FL |   | MEDICAID | ME0046002 | 01 | FL | MEDICAL LICENSE | OTHER | 043092702 | 05 | FL |   | MEDICAID | ME0039515 | 01 | FL | MEDICAL LICENSE DR. UBALS | OTHER | ME0071552 | 01 | FL | M L - DR. GERSHMAN | OTHER | ME88114 | 01 | FL | MED. LIC. DR. MARK | OTHER | 049010500 | 05 | FL |   | MEDICAID | 251869400 | 05 | FL |   | MEDICAID |