Provider Demographics
NPI:1558664987
Name:MOSHE STAV MD PA
Entity Type:Organization
Organization Name:MOSHE STAV MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MOSHE
Authorized Official - Middle Name:
Authorized Official - Last Name:STAV
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-401-6060
Mailing Address - Street 1:1550 PONCE DE LEON DR
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33316-1324
Mailing Address - Country:US
Mailing Address - Phone:954-401-6060
Mailing Address - Fax:954-766-8434
Practice Address - Street 1:1550 PONCE DE LEON DR
Practice Address - Street 2:3200 S. UNIVERSITY DR, RM 7374
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33316-1324
Practice Address - Country:US
Practice Address - Phone:954-401-6060
Practice Address - Fax:954-766-8434
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-07
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma SurgeryGroup - Single Specialty