Provider Demographics
NPI:1033414610
Name:BEICHMAN, PETER (ADMINISTRATOR)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:BEICHMAN
Suffix:
Gender:M
Credentials:ADMINISTRATOR
Other - Prefix:
Other - First Name:GLORIA
Other - Middle Name:
Other - Last Name:WELT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PRESIDENT
Mailing Address - Street 1:1210 S FEDERAL HWY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33435-6044
Mailing Address - Country:US
Mailing Address - Phone:561-752-9888
Mailing Address - Fax:561-752-9899
Practice Address - Street 1:1210 S FEDERAL HWY
Practice Address - Street 2:SUITE 101
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33435-6044
Practice Address - Country:US
Practice Address - Phone:561-752-9888
Practice Address - Fax:561-752-9899
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-13
Last Update Date:2011-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL299991436163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL679588900Medicaid