Provider Demographics
NPI:1457897241
Name:PATH MEDICAL, LLC
Entity Type:Organization
Organization Name:PATH MEDICAL, LLC
Other - Org Name:PATH MEDICAL - CUTLER BAY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF MEDICAL SERVICES
Authorized Official - Prefix:DR
Authorized Official - First Name:NEIL
Authorized Official - Middle Name:
Authorized Official - Last Name:BONNARDALE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:754-218-2164
Mailing Address - Street 1:2304 W OAKLAND PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:OAKLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33311-1422
Mailing Address - Country:US
Mailing Address - Phone:754-218-2164
Mailing Address - Fax:407-730-9928
Practice Address - Street 1:11285 SW 211TH ST STE 302
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33189-2213
Practice Address - Country:US
Practice Address - Phone:386-960-2345
Practice Address - Fax:386-960-2350
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PATH MEDICAL CENTER HOLDINGS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-01-17
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC8638261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========OtherPIP