Provider Demographics
NPI:1093020554
Name:MEDICAL ASSOCIATES NETWORK, LLC
Entity Type:Organization
Organization Name:MEDICAL ASSOCIATES NETWORK, LLC
Other - Org Name:MEDICAL ASSOCIATES NETWORK, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:O
Authorized Official - Last Name:PANTALEON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-882-1460
Mailing Address - Street 1:3115 W 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-5307
Mailing Address - Country:US
Mailing Address - Phone:305-882-1460
Mailing Address - Fax:305-882-1465
Practice Address - Street 1:3115 W 4TH AVE
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-5307
Practice Address - Country:US
Practice Address - Phone:305-882-1460
Practice Address - Fax:305-882-1465
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-09
Last Update Date:2010-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273Y00000XHospital UnitsRehabilitation Unit