Provider Demographics
NPI:1033498837
Name:GARDENS FAMILY PRACTICE, PA
Entity Type:Organization
Organization Name:GARDENS FAMILY PRACTICE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:PRABHAVATHI
Authorized Official - Middle Name:
Authorized Official - Last Name:VIRALAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-627-7433
Mailing Address - Street 1:3365 BURNS RD
Mailing Address - Street 2:STUITE 217
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-4326
Mailing Address - Country:US
Mailing Address - Phone:561-627-7433
Mailing Address - Fax:561-775-1055
Practice Address - Street 1:3365 BURNS RD
Practice Address - Street 2:STUITE 217
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-4326
Practice Address - Country:US
Practice Address - Phone:561-627-7433
Practice Address - Fax:561-775-1055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-10
Last Update Date:2011-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME63002207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty