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NPI Code Detail

MEDICARE: FT PIERCE FL OPCO LLC

MEDICARE: FT PIERCE FL OPCO LLC
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
1314000000XSkilled Nursing Facility

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1598381584
Entity Type Code : Organization
Provider Name (Legal Business Name) : FT PIERCE FL OPCO LLC
Provider Business Mailing Address
First Line : 2071 FLATBUSH AVE STE 12
Second Line :
City : BROOKLYN
State : NY
Zip : 11234-4340
Country : US
Telephone Number : 973-925-3996
Fax Number :
Provider Business Practice Location Address
First Line : 700 S 29TH ST
Second Line :
City : FORT PIERCE
State : FL
Zip : 34947-3626
Country : US
Telephone Number : 646-649-1131
Fax Number :
Authorized Official
Title or Position : CEO
Name : DAVID HERSKOWITZ
Credential :
Telephone Number : 212-444-1991
Provider Enumeration Date : 06/25/2020
Last Update Date : 02/08/2023

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Directions to “FT PIERCE FL OPCO LLC ” Practice Location

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