Provider Demographics
NPI:1417238650
Name:ATLANTIC PEDIATRIC PARTNERS LLC
Entity Type:Organization
Organization Name:ATLANTIC PEDIATRIC PARTNERS LLC
Other - Org Name:SOUTH FLORIDA PEDIATRIC PARTNERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:J
Authorized Official - Last Name:GOLDBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-435-7400
Mailing Address - Street 1:7800 SW 87TH AVE
Mailing Address - Street 2:SUITE C-350
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-2539
Mailing Address - Country:US
Mailing Address - Phone:954-731-9676
Mailing Address - Fax:954-731-9747
Practice Address - Street 1:6963 SW 117TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33183-2803
Practice Address - Country:US
Practice Address - Phone:305-595-3225
Practice Address - Fax:305-595-7812
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-01
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME49566208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL259723312Medicaid