Healthcare Provider Details

I. General information

NPI: 1629743562
Provider Name (Legal Business Name): MIMOSA FAMILY HEALTH PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2021
Last Update Date: 08/12/2021
Certification Date: 08/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

960 W 41ST ST STE 312
MIAMI BEACH FL
33140-3348
US

IV. Provider business mailing address

200 WALLABOUT ST STE 1C
BROOKLYN NY
11206-5561
US

V. Phone/Fax

Practice location:
  • Phone: 718-486-9800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: YECHIEL ZAGELBAUM
Title or Position: DO
Credential:
Phone: 718-486-9800