Healthcare Provider Details

I. General information

NPI: 1922079185
Provider Name (Legal Business Name): AYUB SOKOL MATZKOWITZ SENNABAUM MDS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2006
Last Update Date: 08/18/2008
Certification Date:
Deactivation Date: 03/27/2008
Reactivation Date: 08/18/2008

III. Provider practice location address

7651 MEDICAL DR
HUDSON FL
34667-6594
US

IV. Provider business mailing address

7651 MEDICAL DR
HUDSON FL
34667
US

V. Phone/Fax

Practice location:
  • Phone: 727-686-9208
  • Fax: 727-868-6420
Mailing address:
  • Phone: 727-868-9208
  • Fax: 727-868-6420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number
License Number StateFL

VIII. Authorized Official

Name: JORGE AYUB
Title or Position: V PRESIDENT
Credential: MD
Phone: 727-868-9208