Provider Demographics
NPI:1568643039
Name:BABYLON CLINIC INC
Entity Type:Organization
Organization Name:BABYLON CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EUGEN
Authorized Official - Middle Name:
Authorized Official - Last Name:LUIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-643-8130
Mailing Address - Street 1:351 NW 42ND AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-5685
Mailing Address - Country:US
Mailing Address - Phone:305-643-8130
Mailing Address - Fax:305-643-8132
Practice Address - Street 1:351 NW 42ND AVE STE 102
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-5685
Practice Address - Country:US
Practice Address - Phone:305-643-8130
Practice Address - Fax:305-643-8132
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-26
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC6279261Q00000X
261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL113465800Medicaid
FLAJ825OtherMEDICARE PTAN