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NPI Code Detail

MEDICARE: ROSLYN PASS PHD PA

MEDICARE: ROSLYN PASS PHD PA
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
1103T00000XPsychologist

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
21942220322OTHERFLMEDICARE NPI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
174202OTHERFLBC/BS

General Provider Information

NPI Number : 1790978435
Entity Type Code : Organization
Provider Name (Legal Business Name) : ROSLYN PASS PHD PA
Provider Business Mailing Address
First Line : 9085 SW 87TH AVE
Second Line : SUITE 201
City : MIAMI
State : FL
Zip : 33176-2309
Country : US
Telephone Number : 305-595-2077
Fax Number :
Provider Business Practice Location Address
First Line : 9085 SW 87TH AVE
Second Line : SUITE 201
City : MIAMI
State : FL
Zip : 33176-2309
Country : US
Telephone Number : 305-595-2077
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : DR. ROSLYN PASS
Credential : PH.D.
Telephone Number : 305-595-2600
Provider Enumeration Date : 08/27/2007
Last Update Date : 11/06/2007

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Directions to “ROSLYN PASS PHD PA ” Practice Location

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