Provider Demographics
NPI:1376966200
Name:ALL STAR PEDIATRIC CARE ,PA
Entity Type:Organization
Organization Name:ALL STAR PEDIATRIC CARE ,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SAM
Authorized Official - Middle Name:A
Authorized Official - Last Name:SKAFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-255-7827
Mailing Address - Street 1:PO BOX 823610
Mailing Address - Street 2:ALL STAR PEDIATRIC CARE ,PA
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33082-3610
Mailing Address - Country:US
Mailing Address - Phone:954-255-7827
Mailing Address - Fax:
Practice Address - Street 1:1951 SW 172ND AVE
Practice Address - Street 2:MEMORIAL HOSPITAL MIRAMAR MEDICAL OFFICE BUILDING # 417
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33029-5593
Practice Address - Country:US
Practice Address - Phone:954-255-7827
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-29
Last Update Date:2014-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME102179208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty