Provider Demographics
NPI:1093871568
Name:NORTH SHORE EKG ASSOCIATES INC
Entity Type:Organization
Organization Name:NORTH SHORE EKG ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:
Authorized Official - Last Name:CENTURION
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-665-4614
Mailing Address - Street 1:5927 SW 70TH ST # 439031
Mailing Address - Street 2:
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-3527
Mailing Address - Country:US
Mailing Address - Phone:305-665-4614
Mailing Address - Fax:305-667-0239
Practice Address - Street 1:1100 NW 95TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33150-2038
Practice Address - Country:US
Practice Address - Phone:305-665-4614
Practice Address - Fax:305-667-0239
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-29
Last Update Date:2015-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL379174200Medicaid
FL98356Medicare ID - Type Unspecified