Provider Demographics
NPI:1013945179
Name:NEY F ANDUJAR, M.D. PA
Entity type:Organization
Organization Name:NEY F ANDUJAR, M.D. PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NEY
Authorized Official - Middle Name:F
Authorized Official - Last Name:ANDUJAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:772-905-8531
Mailing Address - Street 1:1401 SE GOLDTREE DR STE 104
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-7584
Mailing Address - Country:US
Mailing Address - Phone:772-905-8531
Mailing Address - Fax:772-905-8526
Practice Address - Street 1:1401 SE GOLDTREE DR STE 104
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-7584
Practice Address - Country:US
Practice Address - Phone:772-905-8531
Practice Address - Fax:772-905-8526
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-29
Last Update Date:2014-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME80487174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLH03544Medicare UPIN
FLK7940Medicare ID - Type UnspecifiedGROUP NUMBER