Provider Demographics
NPI:1891794103
Name:ANDREW H ZWICK MD LLC
Entity Type:Organization
Organization Name:ANDREW H ZWICK MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:HARRISON
Authorized Official - Last Name:ZWICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-395-2424
Mailing Address - Street 1:5458 TOWN CENTER RD
Mailing Address - Street 2:SUITE 19
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33486-1089
Mailing Address - Country:US
Mailing Address - Phone:561-395-2424
Mailing Address - Fax:561-395-2709
Practice Address - Street 1:5458 TOWN CENTER RD
Practice Address - Street 2:SUITE 19
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486-1089
Practice Address - Country:US
Practice Address - Phone:561-395-2424
Practice Address - Fax:561-395-2709
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-19
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0065365174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL5521288OtherAETNA PROV NUMBER
FL28433OtherBC/BS HEALTH OPTIONS NUMB
FL2983677-007OtherCIGNA PROVIDER NUMBER
FLME0065365OtherFL LICENSE NUMBER
FLME0065365OtherFL LICENSE NUMBER
FLG23617Medicare UPIN
FL28433YMedicare ID - Type UnspecifiedDR ZWICK'S MCR NUMBER