Provider Demographics
NPI:1720374077
Name:PHYSICIAN EXTENDERS SERVICES NAPLES, INC.
Entity Type:Organization
Organization Name:PHYSICIAN EXTENDERS SERVICES NAPLES, INC.
Other - Org Name:THE EXTENDERS GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RICK
Authorized Official - Middle Name:
Authorized Official - Last Name:YAROSH
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:954-455-5833
Mailing Address - Street 1:1001 N FEDERAL HWY
Mailing Address - Street 2:SUITE 355
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-2400
Mailing Address - Country:US
Mailing Address - Phone:954-455-5833
Mailing Address - Fax:866-902-8817
Practice Address - Street 1:1001 N FEDERAL HWY
Practice Address - Street 2:SUITE 355
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-2400
Practice Address - Country:US
Practice Address - Phone:954-455-5833
Practice Address - Fax:866-902-8817
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-24
Last Update Date:2011-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9101963363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty