=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013110790
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MARGATE PEDIATRICS PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/08/2007
-----------------------------------------------------
Last Update Date | 04/05/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5100 WEST COPANS ROAD SUITE 800
-----------------------------------------------------
City | MARGATE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33063
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-975-4611
-----------------------------------------------------
Fax | 954-975-4079
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5100 WEST COPANS ROAD SUITE 800
-----------------------------------------------------
City | MARGATE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33063
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-975-4611
-----------------------------------------------------
Fax | 954-975-4079
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. ALIYA ASAD
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 954-975-4611
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | ME83289
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | ME83289
-----------------------------------------------------
License Number State |
-----------------------------------------------------