Provider Demographics
NPI:1568886323
Name:DR PROSPER ABITBOL PA
Entity Type:Organization
Organization Name:DR PROSPER ABITBOL PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PROSPER
Authorized Official - Middle Name:
Authorized Official - Last Name:ABITBOL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:954-347-7400
Mailing Address - Street 1:801 MEADOWS RD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33486-2346
Mailing Address - Country:US
Mailing Address - Phone:561-347-7400
Mailing Address - Fax:561-347-7555
Practice Address - Street 1:801 MEADOWS RD
Practice Address - Street 2:SUITE 107
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486-2346
Practice Address - Country:US
Practice Address - Phone:561-347-7400
Practice Address - Fax:561-347-7555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-13
Last Update Date:2014-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS7195207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty