Provider Demographics
NPI:1558324848
Name:PEDIATRIC ENDOCRINE & DIABETES SPECAILISTS, PA
Entity Type:Organization
Organization Name:PEDIATRIC ENDOCRINE & DIABETES SPECAILISTS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:A
Authorized Official - Last Name:VACCARELLO-CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-624-1985
Mailing Address - Street 1:3400 BURNS RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-4325
Mailing Address - Country:US
Mailing Address - Phone:561-624-1985
Mailing Address - Fax:561-624-7255
Practice Address - Street 1:3400 BURNS RD
Practice Address - Street 2:SUITE 200
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-4325
Practice Address - Country:US
Practice Address - Phone:561-624-1985
Practice Address - Fax:561-624-7255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00560442080P0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric EndocrinologyGroup - Single Specialty