Provider Demographics
NPI:1649304536
Name:OPTIMAL HEALTH PARTNERS,LLC
Entity type:Organization
Organization Name:OPTIMAL HEALTH PARTNERS,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:CENNAMO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:954-318-0873
Mailing Address - Street 1:2708 E OAKLAND PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33306-1605
Mailing Address - Country:US
Mailing Address - Phone:954-318-0873
Mailing Address - Fax:
Practice Address - Street 1:2708 E OAKLAND PARK BLVD
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33306-1605
Practice Address - Country:US
Practice Address - Phone:954-318-0873
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS8515207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF45811Medicare UPIN
FLK6663Medicare ID - Type Unspecified