Provider Demographics
NPI:1164404182
Name:STREISAND, WARREN JAY (MD)
Entity Type:Individual
Prefix:DR
First Name:WARREN
Middle Name:JAY
Last Name:STREISAND
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7421 UNIVERSITY DRIVE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33321-2952
Mailing Address - Country:US
Mailing Address - Phone:954-722-0150
Mailing Address - Fax:954-722-0188
Practice Address - Street 1:7421 UNIVERSITY DRIVE
Practice Address - Street 2:SUITE 106
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-2952
Practice Address - Country:US
Practice Address - Phone:954-722-0150
Practice Address - Fax:954-722-0188
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-16
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME19696208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL054914200Medicaid
93116ZMedicare ID - Type Unspecified
FL054914200Medicaid