Provider Demographics
NPI:1114269933
Name:PHYSICIAN'S AT HOME VISITING PROGRAM, INC.
Entity Type:Organization
Organization Name:PHYSICIAN'S AT HOME VISITING PROGRAM, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SIMON
Authorized Official - Middle Name:C
Authorized Official - Last Name:ABELSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:786-269-7939
Mailing Address - Street 1:7085 SW 47TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-4652
Mailing Address - Country:US
Mailing Address - Phone:786-269-7939
Mailing Address - Fax:
Practice Address - Street 1:7085 SW 47TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-4652
Practice Address - Country:US
Practice Address - Phone:786-269-7939
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-19
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME93384207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Single Specialty