Healthcare Provider Details

I. General information

NPI: 1174125561
Provider Name (Legal Business Name): PM PEDIATRICS OF FLORIDA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2020
Last Update Date: 06/23/2025
Certification Date: 06/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5992 CORAL RIDGE DR
CORAL SPRINGS FL
33076-3302
US

IV. Provider business mailing address

1 HOLLOW LN STE 301
NEW HYDE PARK NY
11042-1215
US

V. Phone/Fax

Practice location:
  • Phone: 754-484-4767
  • Fax: 754-484-4480
Mailing address:
  • Phone: 516-869-0650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DANIELLE MARIE LOPEZ
Title or Position: DIRECTOR CREDENTIALING/ENROLLMENT
Credential:
Phone: 516-207-7936