Provider Demographics
NPI:1346504990
Name:ADAGIO MEDICAL LLC
Entity Type:Organization
Organization Name:ADAGIO MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL ASSISTAN
Authorized Official - Prefix:
Authorized Official - First Name:MARJORIE
Authorized Official - Middle Name:
Authorized Official - Last Name:VELASCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-377-4682
Mailing Address - Street 1:19101 MYSTIC POINTE DR
Mailing Address - Street 2:SUIT 2604
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-4512
Mailing Address - Country:US
Mailing Address - Phone:908-347-3131
Mailing Address - Fax:786-284-8459
Practice Address - Street 1:4302 ALTON RD
Practice Address - Street 2:SUIT 105
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33140-2891
Practice Address - Country:US
Practice Address - Phone:786-463-1786
Practice Address - Fax:786-284-8459
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-28
Last Update Date:2012-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJC52536Medicare UPIN