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General NPI Number Information
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NPI Number | 1114228368
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Entity Type | Organization
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Legal Business Name | MANOR MEDICAL CENTER INC.
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Dates
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Enumeration Date | 11/04/2010
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Last Update Date | 02/17/2022
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Provider Practice Location Address
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Address Line | 1000 NW 10TH AVE
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City | FORT LAUDERDALE
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State | FL
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Zip | 33311-6137
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Country | US
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Telephone | 954-728-9200
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Fax | 954-728-8660
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Provider Business Mailing Address
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Address Line | 1040 NW 10TH AVE
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City | FORT LAUDERDALE
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State | FL
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Zip | 33311-6101
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Country | US
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Telephone | 954-728-9200
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Fax | 954-728-8660
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Authorized Official
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Title or Position | MEDICAL DOCTOR
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Name | YVES MICHEL ANTOINE JODESTY SR.
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Credential | MD
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Telephone | 954-728-9200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME49891
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License Number State | FL
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