Provider Demographics
NPI:1952350076
Name:MOUM & NIELSEN PA
Entity Type:Organization
Organization Name:MOUM & NIELSEN PA
Other - Org Name:DERNATOLOGY ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:EE
Authorized Official - Last Name:MOUM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-395-8701
Mailing Address - Street 1:445 FEDERAL HWY
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33432
Mailing Address - Country:US
Mailing Address - Phone:561-395-8701
Mailing Address - Fax:561-367-9338
Practice Address - Street 1:445 FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33432
Practice Address - Country:US
Practice Address - Phone:561-395-8701
Practice Address - Fax:561-367-9338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL00354OtherBCBS GROUP
FL00354Medicare ID - Type UnspecifiedGROUP
FL00354OtherBCBS GROUP