Provider Demographics
NPI:1801834213
Name:THE CENTRE FOR INTERNAL MEDICINE PA
Entity Type:Organization
Organization Name:THE CENTRE FOR INTERNAL MEDICINE PA
Other - Org Name:WILBUR GREENSTEIN QUINTELA MDS PA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PABLO
Authorized Official - Middle Name:
Authorized Official - Last Name:QUINTELA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-437-1500
Mailing Address - Street 1:11011 SHERIDAN STREET
Mailing Address - Street 2:SUITE 302
Mailing Address - City:COOPER CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33026-1532
Mailing Address - Country:US
Mailing Address - Phone:954-437-1500
Mailing Address - Fax:954-437-0136
Practice Address - Street 1:11011 SHERIDAN STREET
Practice Address - Street 2:SUITE 302
Practice Address - City:COOPER CITY
Practice Address - State:FL
Practice Address - Zip Code:33026-1532
Practice Address - Country:US
Practice Address - Phone:954-437-1500
Practice Address - Fax:954-437-0136
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2019-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME81652207Q00000X
FLME64557207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL99758Medicare ID - Type Unspecified