Provider Demographics
NPI:1114228368
Name:MANOR MEDICAL CENTER INC.
Entity Type:Organization
Organization Name:MANOR MEDICAL CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:YVES
Authorized Official - Middle Name:MICHEL ANTOINE
Authorized Official - Last Name:JODESTY
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD
Authorized Official - Phone:954-728-9200
Mailing Address - Street 1:1040 NW 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33311-6101
Mailing Address - Country:US
Mailing Address - Phone:954-728-9200
Mailing Address - Fax:954-728-8660
Practice Address - Street 1:1000 NW 10TH AVE
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33311-6137
Practice Address - Country:US
Practice Address - Phone:954-728-9200
Practice Address - Fax:954-728-8660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-04
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME49891207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty