Provider Demographics
NPI:1386664621
Name:HARBORSIDE INTERNAL MEDICINE PA
Entity Type:Organization
Organization Name:HARBORSIDE INTERNAL MEDICINE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:A
Authorized Official - Last Name:JANZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-637-1119
Mailing Address - Street 1:522 E MARION AVE
Mailing Address - Street 2:
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33950-3814
Mailing Address - Country:US
Mailing Address - Phone:941-637-1119
Mailing Address - Fax:941-637-1739
Practice Address - Street 1:522 E MARION AVE
Practice Address - Street 2:
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33950-3875
Practice Address - Country:US
Practice Address - Phone:941-637-1119
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME71373207R00000X
FLME48819207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty