Provider Demographics
NPI:1922009232
Name:BOYNTON BEACH ENDOCRINOLOGY PA
Entity Type:Organization
Organization Name:BOYNTON BEACH ENDOCRINOLOGY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:MELLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-374-9707
Mailing Address - Street 1:11135 S JOG RD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33437-1807
Mailing Address - Country:US
Mailing Address - Phone:561-374-9707
Mailing Address - Fax:561-374-8929
Practice Address - Street 1:11135 S JOG RD
Practice Address - Street 2:SUITE 5
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33437-1807
Practice Address - Country:US
Practice Address - Phone:561-374-9707
Practice Address - Fax:561-374-8929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-09
Last Update Date:2011-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME60362174400000X
FLME81294174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL14496ZMedicare PIN
FLE6183ZMedicare PIN