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General NPI Number Information
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NPI Number | 1023141819
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Entity Type | Organization
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Legal Business Name | CENTRAL FLORIDA INJURY EAST, INC
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Dates
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Enumeration Date | 03/13/2007
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Last Update Date | 12/06/2016
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Provider Practice Location Address
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Address Line | 5555 E MICHIGAN ST SUITE 102
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City | ORLANDO
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State | FL
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Zip | 32822-2700
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Country | US
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Telephone | 407-275-9334
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Fax | 407-275-9395
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Provider Business Mailing Address
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Address Line | 5555 E MICHIGAN ST SUITE 102
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City | ORLANDO
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State | FL
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Zip | 32822-2700
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Country | US
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Telephone | 407-275-9334
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Fax | 407-275-9395
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. JEROLD J FADEM JR.
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Credential | M.D.
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Telephone | 407-275-9334
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | ME 8351
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME 75343
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License Number State | FL
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