Provider Demographics
NPI:1154652824
Name:JUSTIN YOVINO MD PA
Entity Type:Organization
Organization Name:JUSTIN YOVINO MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:YOVINO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-565-2330
Mailing Address - Street 1:910 NE 26TH AVE
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33304-3607
Mailing Address - Country:US
Mailing Address - Phone:954-565-2330
Mailing Address - Fax:954-565-8994
Practice Address - Street 1:910 NE 26TH AVE
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33304-3607
Practice Address - Country:US
Practice Address - Phone:954-565-2330
Practice Address - Fax:954-565-8994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-20
Last Update Date:2010-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME103236208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001345900Medicaid
FLBZ984AMedicare UPIN