Provider Demographics
NPI:1932590411
Name:SALTZMAN, TANIS, PITTEL, LEVIN AND JACOBSON
Entity Type:Organization
Organization Name:SALTZMAN, TANIS, PITTEL, LEVIN AND JACOBSON
Other - Org Name:PEDIATRIC ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:CORSIATTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-967-6400
Mailing Address - Street 1:900 S PINE ISLAND RD
Mailing Address - Street 2:SUITE 800
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-3920
Mailing Address - Country:US
Mailing Address - Phone:954-967-6400
Mailing Address - Fax:954-965-7339
Practice Address - Street 1:379 N CONGRESS AVE
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33426-3415
Practice Address - Country:US
Practice Address - Phone:561-336-0191
Practice Address - Fax:561-364-7785
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-05
Last Update Date:2016-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL373797738Medicaid