Provider Demographics
NPI:1780952143
Name:SERGIO MENENDEZ-APONTE,MD,PA
Entity type:Organization
Organization Name:SERGIO MENENDEZ-APONTE,MD,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SERGIO
Authorized Official - Middle Name:LUIS
Authorized Official - Last Name:MENENDEZ-APONTE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-645-5998
Mailing Address - Street 1:120 BENMORE DR
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-4101
Mailing Address - Country:US
Mailing Address - Phone:407-645-5998
Mailing Address - Fax:407-645-3301
Practice Address - Street 1:120 BENMORE DR
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-4101
Practice Address - Country:US
Practice Address - Phone:407-645-5998
Practice Address - Fax:407-645-3301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-13
Last Update Date:2012-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0048035261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLFN676AMedicare PIN
FLE-21346Medicare UPIN