=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033793096
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FIRSTDAY HEALTHCARE NEONATE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/06/2021
-----------------------------------------------------
Last Update Date | 05/06/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2234 N FEDERAL HWY # 3129
-----------------------------------------------------
City | BOCA RATON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33431-7710
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-306-5469
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2234 N FEDERAL HWY # 3129
-----------------------------------------------------
City | BOCA RATON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33431-7710
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-306-5469
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | ROSS SOMMERS
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 561-306-5469
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2080N0001X
-----------------------------------------------------
Taxonomy Name | Neonatal-Perinatal Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------