Provider Demographics
NPI:1326286204
Name:COSMETIC VEIN CLINIC OF FLORIDA INC
Entity Type:Organization
Organization Name:COSMETIC VEIN CLINIC OF FLORIDA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:P
Authorized Official - Last Name:PECORARO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-761-1746
Mailing Address - Street 1:2225 59TH ST W
Mailing Address - Street 2:SUITE B
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34209-7017
Mailing Address - Country:US
Mailing Address - Phone:941-761-1746
Mailing Address - Fax:941-761-0188
Practice Address - Street 1:2225 59TH ST W
Practice Address - Street 2:SUITE B
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34209-7017
Practice Address - Country:US
Practice Address - Phone:941-761-1746
Practice Address - Fax:941-761-0188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-30
Last Update Date:2009-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME59036174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL263214400Medicaid