Provider Demographics
NPI:1306356472
Name:MEDICAL ASSOCIATES NETWORK, LLC
Entity Type:Organization
Organization Name:MEDICAL ASSOCIATES NETWORK, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:O
Authorized Official - Last Name:PANTALEON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-239-8167
Mailing Address - Street 1:3500 HOLLYWOOD BLVD STE C3500
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-6809
Mailing Address - Country:US
Mailing Address - Phone:954-239-8167
Mailing Address - Fax:954-289-5948
Practice Address - Street 1:3500 HOLLYWOOD BLVD STE C3500
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-6809
Practice Address - Country:US
Practice Address - Phone:954-239-8167
Practice Address - Fax:954-289-5948
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-03
Last Update Date:2017-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME63889261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy