Provider Demographics
NPI:1790915304
Name:ALEISHA OLBY-CANIK DO LLC
Entity Type:Organization
Organization Name:ALEISHA OLBY-CANIK DO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALEISHA
Authorized Official - Middle Name:A
Authorized Official - Last Name:OLBY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:954-449-3763
Mailing Address - Street 1:200 SE 3RD ST
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33060-7118
Mailing Address - Country:US
Mailing Address - Phone:954-449-3763
Mailing Address - Fax:
Practice Address - Street 1:2900 N MILITARY TRL
Practice Address - Street 2:SUITE 245
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-6365
Practice Address - Country:US
Practice Address - Phone:561-994-2007
Practice Address - Fax:561-994-2003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-16
Last Update Date:2009-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty