Healthcare Provider Details

I. General information

NPI: 1659300887
Provider Name (Legal Business Name): ELIE DUMENY JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2006
Last Update Date: 01/31/2024
Certification Date: 01/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

599 S FEDERAL HWY STE 104
DANIA FL
33004-4175
US

IV. Provider business mailing address

599 S FEDERAL HWY STE 104
DANIA FL
33004-4175
US

V. Phone/Fax

Practice location:
  • Phone: 954-927-2752
  • Fax: 954-927-6701
Mailing address:
  • Phone: 954-927-2752
  • Fax: 954-927-6701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberME69459
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberME69459
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: