Provider Demographics
NPI:1508103755
Name:MSMC NEONATOLOGY, LLC
Entity Type:Organization
Organization Name:MSMC NEONATOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHUTKAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-674-2662
Mailing Address - Street 1:PO BOX 12140
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33101-2140
Mailing Address - Country:US
Mailing Address - Phone:305-674-2727
Mailing Address - Fax:305-674-2304
Practice Address - Street 1:4300 ALTON RD
Practice Address - Street 2:BLUM BUILDING, THIRD FLOOR
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33140-2948
Practice Address - Country:US
Practice Address - Phone:305-674-2727
Practice Address - Fax:305-674-2304
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MOUNT SINAI MEDICAL CENTER OF FLORIDA, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-01-08
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal MedicineGroup - Single Specialty