Provider Demographics
NPI:1871841585
Name:SA MEDICAL PHYSICIANS OF FL PA
Entity Type:Organization
Organization Name:SA MEDICAL PHYSICIANS OF FL PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KHASHAYAR
Authorized Official - Middle Name:
Authorized Official - Last Name:VOSOUGH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-826-8287
Mailing Address - Street 1:145 ROUTE 46 WEST
Mailing Address - Street 2:SUITE 304
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-6830
Mailing Address - Country:US
Mailing Address - Phone:973-826-8287
Mailing Address - Fax:855-834-5435
Practice Address - Street 1:9325 GLADES RD
Practice Address - Street 2:SUITE 105
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33434-3988
Practice Address - Country:US
Practice Address - Phone:561-362-4400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-28
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty