Provider Demographics
NPI:1346231016
Name:SOUTH FLORIDA DIAGNOSTIC ASSOCIATES
Entity Type:Organization
Organization Name:SOUTH FLORIDA DIAGNOSTIC ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:NIERENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-442-9726
Mailing Address - Street 1:15211 LAUREL LN S
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33027-1330
Mailing Address - Country:US
Mailing Address - Phone:954-442-9726
Mailing Address - Fax:954-442-6817
Practice Address - Street 1:20020 VETERANS BLVD
Practice Address - Street 2:SUITE 20
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33954-2114
Practice Address - Country:US
Practice Address - Phone:941-623-0460
Practice Address - Fax:941-613-0461
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC6245261QS1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU4641Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER