Provider Demographics
NPI:1689640328
Name:PBD&P INC
Entity Type:Organization
Organization Name:PBD&P INC
Other - Org Name:PALM BEACH DERMATOLOGY INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:O
Authorized Official - Last Name:SOKOLOFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-840-0995
Mailing Address - Street 1:4475 MEDICAL CENTER WAY
Mailing Address - Street 2:SUITE 1
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33407-3240
Mailing Address - Country:US
Mailing Address - Phone:561-840-0995
Mailing Address - Fax:561-840-0661
Practice Address - Street 1:4475 MEDICAL CENTER WAY
Practice Address - Street 2:SUITE 2
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407-3240
Practice Address - Country:US
Practice Address - Phone:561-840-0995
Practice Address - Fax:561-840-0661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-23
Last Update Date:2012-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathologyGroup - Multi-Specialty
No207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL21482OtherBLUE CROSS GROUP NUMBER
FLK0388GMedicare PIN
FLK0388DMedicare PIN
FL21482OtherBLUE CROSS GROUP NUMBER
FLK0388BMedicare PIN
FLK0388HMedicare PIN
FLK0388FMedicare PIN
FLK0388CMedicare PIN
FLK0388EMedicare PIN