Provider Demographics
NPI:1477299238
Name:BDL NATIONAL INC
Entity Type:Organization
Organization Name:BDL NATIONAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:W
Authorized Official - Last Name:GOLDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-684-4744
Mailing Address - Street 1:508 CORNER DR
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-5717
Mailing Address - Country:US
Mailing Address - Phone:813-684-4744
Mailing Address - Fax:813-571-5557
Practice Address - Street 1:508 CORNER DR
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-5717
Practice Address - Country:US
Practice Address - Phone:813-684-4744
Practice Address - Fax:813-571-5557
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-05
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QV0200XAmbulatory Health Care FacilitiesClinic/CenterVA