Provider Demographics
NPI:1053657650
Name:MEMORIAL DIVISION OF PEDIATRIC OTOLARYNGOLOGY
Entity Type:Organization
Organization Name:MEMORIAL DIVISION OF PEDIATRIC OTOLARYNGOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OTOLARYNGOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:OSTROWER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-265-1616
Mailing Address - Street 1:1150 N 35TH AVE
Mailing Address - Street 2:SUITE 490
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-5424
Mailing Address - Country:US
Mailing Address - Phone:954-265-1616
Mailing Address - Fax:954-893-6325
Practice Address - Street 1:1150 N 35TH AVE
Practice Address - Street 2:SUITE 490
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-5424
Practice Address - Country:US
Practice Address - Phone:954-265-1616
Practice Address - Fax:954-893-6325
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-31
Last Update Date:2012-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9106938363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPA9106938OtherMEDICAL LICENSE