Provider Demographics
NPI:1194194480
Name:DR DOV PICKHOLTZ DO PA
Entity Type:Organization
Organization Name:DR DOV PICKHOLTZ DO PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DOV
Authorized Official - Middle Name:ALEXANDER
Authorized Official - Last Name:PICKHOLTZ
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:561-450-9933
Mailing Address - Street 1:7964 LITTLE LN
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-4146
Mailing Address - Country:US
Mailing Address - Phone:561-450-9933
Mailing Address - Fax:561-450-9934
Practice Address - Street 1:7964 LITTLE LN
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-4146
Practice Address - Country:US
Practice Address - Phone:561-450-9933
Practice Address - Fax:561-450-9934
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-17
Last Update Date:2015-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS12425207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLOS12425OtherFL LICENCE