Provider Demographics
NPI:1740572478
Name:ANDREW S. LEPOFF DO PA
Entity Type:Organization
Organization Name:ANDREW S. LEPOFF DO PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PRACTIONER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:S
Authorized Official - Last Name:LEPOFF
Authorized Official - Suffix:
Authorized Official - Credentials:DO PA
Authorized Official - Phone:561-840-0491
Mailing Address - Street 1:2051 45TH ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33407-2027
Mailing Address - Country:US
Mailing Address - Phone:561-840-0491
Mailing Address - Fax:561-840-1354
Practice Address - Street 1:2051 45TH ST
Practice Address - Street 2:SUITE 201
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407-2027
Practice Address - Country:US
Practice Address - Phone:561-840-0491
Practice Address - Fax:561-840-1354
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-13
Last Update Date:2011-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS6194208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL058970500Medicaid
FL058970500Medicaid