Provider Demographics
NPI:1790978435
Name:ROSLYN PASS PHD PA
Entity Type:Organization
Organization Name:ROSLYN PASS PHD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:PASS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:305-595-2600
Mailing Address - Street 1:9085 SW 87TH AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-2309
Mailing Address - Country:US
Mailing Address - Phone:305-595-2077
Mailing Address - Fax:
Practice Address - Street 1:9085 SW 87TH AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-2309
Practice Address - Country:US
Practice Address - Phone:305-595-2077
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-27
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL74202OtherBC/BS
FL1942220322OtherMEDICARE NPI