Provider Demographics
NPI:1639297468
Name:JBS MEDICAL PA
Entity Type:Organization
Organization Name:JBS MEDICAL PA
Other - Org Name:ANDREW ROSENTHAL MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSENTHAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-393-8800
Mailing Address - Street 1:7280 W PALMETTO PARK RD STE 305
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-3401
Mailing Address - Country:US
Mailing Address - Phone:561-393-8800
Mailing Address - Fax:561-393-6202
Practice Address - Street 1:7280 W PALMETTO PARK RD STE 305
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-3401
Practice Address - Country:US
Practice Address - Phone:561-393-8800
Practice Address - Fax:561-393-6202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME89367174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
7468622OtherAETNA PROVIDER # FOR ANDREW ROSENTHAL, MD
FL27842OtherBCBS PROVIDER FOR ANDREW ROSENTHAL,MD
38257OtherBCBS GROUP NUMBER
FL16548OtherBCBS NON-PAR PROVIDER # FOR MATTHEW GOODWIN, MD
FL16548OtherBCBS NON-PAR PROVIDER # FOR MATTHEW GOODWIN, MD