Healthcare Provider Details

I. General information

NPI: 1538923560
Provider Name (Legal Business Name): TRIBECA INFUSION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2024
Last Update Date: 02/13/2024
Certification Date: 02/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 ARTHUR GODFREY RD STE 300
MIAMI BEACH FL
33140-3444
US

IV. Provider business mailing address

777 ARTHUR GODFREY RD STE 300
MIAMI BEACH FL
33140-3444
US

V. Phone/Fax

Practice location:
  • Phone: 305-763-8832
  • Fax: 305-763-8883
Mailing address:
  • Phone: 305-763-8832
  • Fax: 305-763-8883

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ELLIOT BERTRAM
Title or Position: CFO
Credential:
Phone: 305-763-8832