Provider Demographics
NPI:1225295892
Name:ARIEL GASTROENTEROLOGY, P.A.
Entity Type:Organization
Organization Name:ARIEL GASTROENTEROLOGY, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED AGENT/GASTROENTEROLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:WILSON
Authorized Official - Middle Name:NICOLAS
Authorized Official - Last Name:OTERO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-483-8422
Mailing Address - Street 1:12400 SW 1ST CT
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33325-2702
Mailing Address - Country:US
Mailing Address - Phone:954-483-8335
Mailing Address - Fax:305-828-6700
Practice Address - Street 1:7100 W 20TH AVE
Practice Address - Street 2:SUITE 412
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-1897
Practice Address - Country:US
Practice Address - Phone:305-820-0006
Practice Address - Fax:305-828-6700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-20
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0044788174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL4073765OtherAETNA NETWORK PROVIDER ID
FL4073765OtherAETNA NETWORK PROVIDER ID