Provider Demographics
NPI:1972687556
Name:ASTHMA & ALLERGY ASSOCIATES OF FL PA
Entity Type:Organization
Organization Name:ASTHMA & ALLERGY ASSOCIATES OF FL PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MONTES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-595-0109
Mailing Address - Street 1:7800 SW 87TH AVE
Mailing Address - Street 2:C-340
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-3570
Mailing Address - Country:US
Mailing Address - Phone:305-595-0109
Mailing Address - Fax:305-595-2836
Practice Address - Street 1:7800 SW 87TH AVE
Practice Address - Street 2:C-340
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-3570
Practice Address - Country:US
Practice Address - Phone:305-595-0109
Practice Address - Fax:305-595-7092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2017-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0046002207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL253284100Medicaid
FLME0046002OtherMEDICAL LICENSE
FL043092702Medicaid
FLME0039515OtherMEDICAL LICENSE DR. UBALS
FLME0071552OtherM L - DR. GERSHMAN
FLME88114OtherMED. LIC. DR. MARK
FL049010500Medicaid
FL251869400Medicaid
FL53829YMedicare ID - Type Unspecified
FL251869400Medicaid
FLE56671Medicare UPIN
FL2528479Medicare ID - Type Unspecified
FL32598Medicare ID - Type Unspecified
FL7679YMedicare ID - Type Unspecified
FL24025Medicare PIN
FLG40205Medicare UPIN
FLME0039515OtherMEDICAL LICENSE DR. UBALS
FLE21397Medicare UPIN
FL02929XMedicare ID - Type Unspecified
FL253284100Medicaid
FL253284100Medicaid