Healthcare Provider Details

I. General information

NPI: 1013950104
Provider Name (Legal Business Name): JACK MURCIANO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 10/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4279 NW 88TH AVE
SUNRISE FL
33351-6044
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 954-741-4280
  • Fax: 954-741-4912
Mailing address:
  • Phone: 954-741-4280
  • Fax: 954-741-4912

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number212728
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME77125
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: