Provider Demographics
NPI:1255466090
Name:CARDIAC INSTITUTE OF THE PALM BEACHES PA
Entity Type:Organization
Organization Name:CARDIAC INSTITUTE OF THE PALM BEACHES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:FENSTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD, FACC
Authorized Official - Phone:561-296-5225
Mailing Address - Street 1:3355 BURNS RD
Mailing Address - Street 2:STE 201
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-4353
Mailing Address - Country:US
Mailing Address - Phone:561-296-5225
Mailing Address - Fax:561-296-5226
Practice Address - Street 1:3355 BURNS RD
Practice Address - Street 2:STE 201
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-4353
Practice Address - Country:US
Practice Address - Phone:561-296-5225
Practice Address - Fax:561-296-5226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2010-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME78204207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK8501Medicare PIN