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General NPI Number Information
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NPI Number | 1124350368
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Entity Type | Organization
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Legal Business Name | SERGE LITVINOV MD PA
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Dates
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Enumeration Date | 02/12/2010
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Last Update Date | 02/12/2010
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Provider Practice Location Address
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Address Line | 2100 E HALLANDALE BEACH BLVD ST 202
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City | HALLANDALE BEACH
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State | FL
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Zip | 33009-3765
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Country | US
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Telephone | 957-239-0578
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Fax |
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Provider Business Mailing Address
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Address Line | 1835 E HALLANDALE BEACH BLVD ST.292
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City | HALLANDALE BEACH
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State | FL
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Zip | 33009-4619
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SERGEY LITVINOV
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Credential | MD
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Telephone | 305-807-7524
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | ME101966
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License Number State | FL
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