Provider Demographics
NPI:1841484029
Name:MOISES SIPERSTEIN MD PA
Entity type:Organization
Organization Name:MOISES SIPERSTEIN MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MOISES
Authorized Official - Middle Name:
Authorized Official - Last Name:SIPERSTEIN-BLUMOVICZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:772-337-7811
Mailing Address - Street 1:10377 S US HIGHWAY 1
Mailing Address - Street 2:SUITE 102
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-5630
Mailing Address - Country:US
Mailing Address - Phone:772-337-7811
Mailing Address - Fax:772-337-7833
Practice Address - Street 1:10377 S US HIGHWAY 1
Practice Address - Street 2:SUITE 102
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-5630
Practice Address - Country:US
Practice Address - Phone:772-337-7811
Practice Address - Fax:772-337-7833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-30
Last Update Date:2014-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME76469207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK4297Medicare PIN