Provider Demographics
NPI:1922272848
Name:PSYCHIATRIC AFFILIATES, P.A.
Entity Type:Organization
Organization Name:PSYCHIATRIC AFFILIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:A
Authorized Official - Last Name:DANZIGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-679-6400
Mailing Address - Street 1:2300 MAITLAND CENTER PKWY
Mailing Address - Street 2:SUITE 230
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-4129
Mailing Address - Country:US
Mailing Address - Phone:407-679-6400
Mailing Address - Fax:407-679-7988
Practice Address - Street 1:2300 MAITLAND CENTER PKWY
Practice Address - Street 2:SUITE 230
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-4129
Practice Address - Country:US
Practice Address - Phone:407-679-6400
Practice Address - Fax:407-679-7988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-22
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME497032084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
D20946Medicare UPIN