Healthcare Provider Details

I. General information

NPI: 1245915669
Provider Name (Legal Business Name): MINOLS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2023
Last Update Date: 06/21/2023
Certification Date: 06/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12425 NW 62ND CT
CORAL SPRINGS FL
33076-1922
US

IV. Provider business mailing address

12425 NW 62ND CT
CORAL SPRINGS FL
33076-1922
US

V. Phone/Fax

Practice location:
  • Phone: 973-803-7229
  • Fax:
Mailing address:
  • Phone: 973-803-7229
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ANTHONY D SLONIM
Title or Position: PRESIDENT
Credential: MD, DRPH
Phone: 973-803-7229