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General NPI Number Information
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NPI Number | 1053657650
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Entity Type | Organization
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Legal Business Name | MEMORIAL DIVISION OF PEDIATRIC OTOLARYNGOLOGY
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Dates
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Enumeration Date | 12/31/2012
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Last Update Date | 12/31/2012
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Provider Practice Location Address
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Address Line | 1150 N 35TH AVE SUITE 490
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City | HOLLYWOOD
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State | FL
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Zip | 33021-5424
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Country | US
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Telephone | 954-265-1616
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Fax | 954-893-6325
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Provider Business Mailing Address
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Address Line | 1150 N 35TH AVE SUITE 490
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City | HOLLYWOOD
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State | FL
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Zip | 33021-5424
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Country | US
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Telephone | 954-265-1616
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Fax | 954-893-6325
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Authorized Official
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Title or Position | OTOLARYNGOLOGIST
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Name | DR. SAMUEL OSTROWER
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Credential | M.D
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Telephone | 954-265-1616
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA9106938
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License Number State | FL
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