Healthcare Provider Details

I. General information

NPI: 1053095265
Provider Name (Legal Business Name): ADVANCED PEDIATRIC PULMONOLOGY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2023
Last Update Date: 08/05/2024
Certification Date: 01/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1971 SW 172ND AVE STE 3128
MIRAMAR FL
33029-5592
US

IV. Provider business mailing address

2701 BISCAYNE BLVD APT 7102
MIAMI FL
33137-5302
US

V. Phone/Fax

Practice location:
  • Phone: 954-299-5272
  • Fax: 855-583-3365
Mailing address:
  • Phone: 914-462-7411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. MARIE MYRTHA GREGOIRE-BOTTEX
Title or Position: MANAGING MEMBER
Credential: MD
Phone: 914-462-7411