Healthcare Provider Details

I. General information

NPI: 1083822621
Provider Name (Legal Business Name): SALTZMAN, TANIS, PITTEL, LEVIN AND JACOBSON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 05/13/2022
Certification Date: 05/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1850 SW FOUNTAINVIEW BLVD SUITE 105
PORT ST LUCIE FL
34986-3443
US

IV. Provider business mailing address

900 S PINE ISLAND RD SUITE 800
PLANTATION FL
33324-3920
US

V. Phone/Fax

Practice location:
  • Phone: 772-336-2818
  • Fax: 772-336-5313
Mailing address:
  • Phone: 772-336-2818
  • Fax: 772-336-5313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DARLENE NEEL
Title or Position: CREDENTIALING COORDINATOR
Credential:
Phone: 954-967-6400