Provider Demographics
NPI:1336250901
Name:HELDFOND,BROOKS,MARGOLIN,ALLEN ET AL A MEDICAL CORP
Entity Type:Organization
Organization Name:HELDFOND,BROOKS,MARGOLIN,ALLEN ET AL A MEDICAL CORP
Other - Org Name:HELDFOND MEDICAL GROUP
Other - Org Type:Other Name
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:PECK
Authorized Official - Last Name:SERDEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-659-9104
Mailing Address - Street 1:8631 W 3RD ST
Mailing Address - Street 2:SUITE 510E
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-5901
Mailing Address - Country:US
Mailing Address - Phone:310-278-1490
Mailing Address - Fax:310-652-3218
Practice Address - Street 1:8631 W 3RD ST
Practice Address - Street 2:SUITE 510E
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-5901
Practice Address - Country:US
Practice Address - Phone:310-278-1490
Practice Address - Fax:310-652-3218
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW1903Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER