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General NPI Number Information
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NPI Number | 1124063540
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Entity Type | Organization
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Legal Business Name | PALM BEACH HEART ASSOCIATES PA
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Dates
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Enumeration Date | 06/19/2006
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Last Update Date | 01/23/2015
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Provider Practice Location Address
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Address Line | 5503 S CONGRESS AVE SUITE 206
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City | ATLANTIS
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State | FL
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Zip | 33462-6625
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Country | US
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Telephone | 561-433-0591
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Fax | 561-433-0891
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Provider Business Mailing Address
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Address Line | 5503 S CONGRESS AVE SUITE 206
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City | ATLANTIS
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State | FL
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Zip | 33462-6625
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Country | US
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Telephone | 561-433-0591
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Fax | 561-433-0891
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JAY MIDWALL
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Credential | MD
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Telephone | 561-433-0591
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number |
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207RI0011X
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Taxonomy Name | Interventional Cardiology Physician
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License Number |
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License Number State | FL
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