Basic Information
| Provider Information | |||||||||
| NPI: | 1710268958 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ATLANTIC PEDIATRIC PARTNERS LLC | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
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| OtherOrganizationName: | SOUTH FLORIDA PEDIATRIC PARTNERS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7800 SW 87TH AVE | ||||||||
| Address2: | SUITE C-350 | ||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331732539 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9547319676 | ||||||||
| FaxNumber: | 9547319747 | ||||||||
| Practice Location | |||||||||
| Address1: | 208 N UNIVERSITY DR | ||||||||
| Address2: | |||||||||
| City: | PEMBROKE PINES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330246716 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9544323888 | ||||||||
| FaxNumber: | 9544321165 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/01/2011 | ||||||||
| LastUpdateDate: | 01/16/2020 | ||||||||
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| AuthorizedOfficialLastName: | GOLDBERG | ||||||||
| AuthorizedOfficialFirstName: | PAUL | ||||||||
| AuthorizedOfficialMiddleName: | J. | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 9544357400 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | |||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | 01/16/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | ME72745 | FL | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 259723308 | 05 | FL | MEDICAID |