Provider Demographics
NPI:1821181348
Name:THEODORE T LAMOTTA, INC
Entity Type:Organization
Organization Name:THEODORE T LAMOTTA, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THEODORE
Authorized Official - Middle Name:T
Authorized Official - Last Name:LAMOTTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-392-6700
Mailing Address - Street 1:9173 SE DEERBERRY PLACE
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33469-1805
Mailing Address - Country:US
Mailing Address - Phone:561-392-6700
Mailing Address - Fax:
Practice Address - Street 1:3900 NW 79 AVE
Practice Address - Street 2:SUITE 728
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33166-6551
Practice Address - Country:US
Practice Address - Phone:305-436-1066
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME93274208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK8553Medicare ID - Type Unspecified