Provider Demographics
NPI:1376910893
Name:DR DOV PICKHOLTZ LLC
Entity Type:Organization
Organization Name:DR DOV PICKHOLTZ LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DOV
Authorized Official - Middle Name:
Authorized Official - Last Name:PICKHOLTZ
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:561-716-8359
Mailing Address - Street 1:5341 W ATLANTIC AVE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33484-8167
Mailing Address - Country:US
Mailing Address - Phone:561-716-8359
Mailing Address - Fax:
Practice Address - Street 1:5341 W ATLANTIC AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33484-8167
Practice Address - Country:US
Practice Address - Phone:561-716-8359
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-01
Last Update Date:2015-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS12425207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty