MEDICARE: MR. ALLEN H ISRAEL M.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	SA8558	FL

General Provider Information

NPI Number	:	1063617249
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ALLEN H ISRAEL M.S.

Provider Business Mailing Address
First Line	:	5201 SW 31ST AVE
Second Line	:	#213
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33312-6920
Country	:	US
Telephone Number	:	954-966-4411
Fax Number	:

Provider Business Practice Location Address
First Line	:	5201 SW 31ST AVE
Second Line	:	#213
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33312-6920
Country	:	US
Telephone Number	:	954-966-4411
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/18/2007
Last Update Date	:	07/08/2007

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Directions to “ MR. ALLEN H ISRAEL M.S.” Practice Location

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