Healthcare Provider Details

I. General information

NPI: 1245577238
Provider Name (Legal Business Name): EIRNY MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2013
Last Update Date: 04/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6844 BRIDLEWOOD CT
BOCA RATON FL
33433-3566
US

IV. Provider business mailing address

6844 BRIDLEWOOD CT
BOCA RATON FL
33433-3566
US

V. Phone/Fax

Practice location:
  • Phone: 561-206-0812
  • Fax:
Mailing address:
  • Phone: 561-206-0812
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: EVA K DANIELSON
Title or Position: CEO
Credential:
Phone: 561-206-0812