Healthcare Provider Details

I. General information

NPI: 1184730889
Provider Name (Legal Business Name): ERIC JOSEPH EXELBERT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 01/05/2024
Certification Date: 01/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3501 JOHNSON ST DIVISION OF PEDIATRIC CRITICAL CARE
HOLLYWOOD FL
33021-5421
US

IV. Provider business mailing address

1117 E HALLANDALE BEACH BLVD
HALLANDALE BEACH FL
33009-4488
US

V. Phone/Fax

Practice location:
  • Phone: 954-457-8771
  • Fax: 954-266-4006
Mailing address:
  • Phone: 954-457-8771
  • Fax: 954-266-4006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD2022-1223
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License NumberME104909
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number104909
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: