Provider Demographics
NPI:1801225875
Name:GERIATRIC PROVIDERS LLC
Entity Type:Organization
Organization Name:GERIATRIC PROVIDERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DINAKAR
Authorized Official - Middle Name:
Authorized Official - Last Name:KOTIYAN
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:561-557-4728
Mailing Address - Street 1:3838 NORTHLAKE BLVD
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33403-1535
Mailing Address - Country:US
Mailing Address - Phone:561-557-4728
Mailing Address - Fax:855-344-0366
Practice Address - Street 1:3838 NORTHLAKE BLVD
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33403-1535
Practice Address - Country:US
Practice Address - Phone:561-557-4728
Practice Address - Fax:855-344-0366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-11
Last Update Date:2013-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLL13000153711OtherNONE