Healthcare Provider Details

I. General information

NPI: 1871578641
Provider Name (Legal Business Name): EAST POMPANO PEDIATRICS CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 EAST SAMPLE ROAD SUITE 107
POMPANO BEACH FL
33064
US

IV. Provider business mailing address

601 EAST SAMPLE ROAD SUITE 107
POMPANO BEACH FL
33064
US

V. Phone/Fax

Practice location:
  • Phone: 954-785-2355
  • Fax: 954-785-0755
Mailing address:
  • Phone: 954-785-2355
  • Fax: 954-785-0755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: HARRY JJ JEAN-BAPTISTE
Title or Position: PRESIDENT
Credential: MD
Phone: 954-785-2355