Healthcare Provider Details

I. General information

NPI: 1760141667
Provider Name (Legal Business Name): SALTZMAN, TANIS, PITTEL, LEVIN AND JACOBSON, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

493 PROSPERITY LAKE DR
ST AUGUSTINE FL
32092-5045
US

IV. Provider business mailing address

900 S PINE ISLAND RD STE 800
PLANTATION FL
33324-3923
US

V. Phone/Fax

Practice location:
  • Phone: 904-824-5437
  • Fax: 904-824-7575
Mailing address:
  • Phone: 954-967-6400
  • 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: DARLENE NEEL
Title or Position: CREDENTIALING COORDINATOR
Credential:
Phone: 954-967-6400