Provider Demographics
NPI:1144214198
Name:POTASHNIK, ALEKSANDR V (PA-C)
Entity Type:Individual
Prefix:MR
First Name:ALEKSANDR
Middle Name:V
Last Name:POTASHNIK
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5301 S CONGRESS AVE
Mailing Address - Street 2:BLDG. #300
Mailing Address - City:ATLANTIS
Mailing Address - State:FL
Mailing Address - Zip Code:33462-1149
Mailing Address - Country:US
Mailing Address - Phone:561-548-4900
Mailing Address - Fax:561-548-4902
Practice Address - Street 1:5301 S CONGRESS AVE
Practice Address - Street 2:BLDG. #300
Practice Address - City:ATLANTIS
Practice Address - State:FL
Practice Address - Zip Code:33462-1149
Practice Address - Country:US
Practice Address - Phone:561-548-4900
Practice Address - Fax:561-548-4902
Is Sole Proprietor?:No
Enumeration Date:2005-09-06
Last Update Date:2013-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9101320363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00684926OtherRAILROAD MEDICARE
FL290891300Medicaid
FLE4612ZOtherMEDICARE ID- TYPE UNSPECI
FLP00684926OtherRAILROAD MEDICARE
FLP14836Medicare UPIN