Provider Demographics
NPI:1265822340
Name:JORDAN FABRIKANT, D.O., P.A.
Entity Type:Organization
Organization Name:JORDAN FABRIKANT, D.O., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JORDAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:FABRIKANT
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:305-284-7742
Mailing Address - Street 1:6140 SW 70TH ST
Mailing Address - Street 2:SECOND FLOOR
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-3419
Mailing Address - Country:US
Mailing Address - Phone:305-284-7577
Mailing Address - Fax:305-675-3714
Practice Address - Street 1:6140 SW 70TH ST
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-3419
Practice Address - Country:US
Practice Address - Phone:305-284-7577
Practice Address - Fax:305-675-3714
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-28
Last Update Date:2015-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty