Healthcare Provider Details

I. General information

NPI: 1760078117
Provider Name (Legal Business Name): SALTZMAN, TANIS, PITTEL, LEVIN AND JACOBSON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2020
Last Update Date: 12/18/2020
Certification Date: 12/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1395 W BAY DR
LARGO FL
33770-2205
US

IV. Provider business mailing address

900 S PINE ISLAND RD STE 800
PLANTATION FL
33324-3923
US

V. Phone/Fax

Practice location:
  • Phone: 954-967-6400
  • Fax: 954-965-7339
Mailing address:
  • Phone: 954-967-6400
  • Fax: 954-965-7339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier373797752
Identifier TypeMEDICAID
Identifier StateFL
Identifier IssuerFlorida Medicaid Provider ID

VIII. Authorized Official

Name: PATRICIA CORSIATTO
Title or Position: DIRECTOR
Credential:
Phone: 954-965-7331