Provider Demographics
NPI:1083822621
Name:SALTZMAN, TANIS, PITTEL, LEVIN AND JACOBSON
Entity Type:Organization
Organization Name:SALTZMAN, TANIS, PITTEL, LEVIN AND JACOBSON
Other - Org Name:PEDIATRIC ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:DARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:NEEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-967-6400
Mailing Address - Street 1:900 S PINE ISLAND RD
Mailing Address - Street 2:SUITE 800
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-3920
Mailing Address - Country:US
Mailing Address - Phone:772-336-2818
Mailing Address - Fax:772-336-5313
Practice Address - Street 1:1850 SW FOUNTAINVIEW BLVD
Practice Address - Street 2:SUITE 105
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34986-3443
Practice Address - Country:US
Practice Address - Phone:772-336-2818
Practice Address - Fax:772-336-5313
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2022-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL373797723Medicaid