Provider Demographics
NPI:1831271949
Name:THEODORE T. LAMOTTA INC
Entity type:Organization
Organization Name:THEODORE T. LAMOTTA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THEODORE
Authorized Official - Middle Name:T
Authorized Official - Last Name:LAMOTTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-436-1066
Mailing Address - Street 1:3900 NW 79 AVENUE
Mailing Address - Street 2:SUITE 728
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33166
Mailing Address - Country:US
Mailing Address - Phone:305-436-1066
Mailing Address - Fax:305-436-1067
Practice Address - Street 1:3900 NW 79 AVENUE
Practice Address - Street 2:SUITE 728
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33166
Practice Address - Country:US
Practice Address - Phone:305-436-1066
Practice Address - Fax:305-436-1067
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK8553Medicare ID - Type UnspecifiedMEDICARE PROVIDER