Healthcare Provider Details

I. General information

NPI: 1609486778
Provider Name (Legal Business Name): LIFETIME MEDICAL ASSOCIATES OF AVENTURA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2020
Last Update Date: 03/24/2025
Certification Date: 03/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21097 NE 27TH CT STE 300
AVENTURA FL
33180-1206
US

IV. Provider business mailing address

21097 NE 27TH CT STE 300
AVENTURA FL
33180-1206
US

V. Phone/Fax

Practice location:
  • Phone: 305-409-0197
  • Fax:
Mailing address:
  • Phone: 786-244-2700
  • Fax: 800-980-3761

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: STACY D ROSKIN
Title or Position: OWNER
Credential: MD
Phone: 305-409-0197