=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225000151
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ROLAND F. BESSIS, PHD PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/04/2006
-----------------------------------------------------
Last Update Date | 10/20/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3400 CORAL WAY SUITE 601
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33145-3070
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-538-5811
-----------------------------------------------------
Fax | 954-926-5804
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 939 HOLLYWOOD BLVD
-----------------------------------------------------
City | HOLLYWOOD
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33019-1605
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-926-7486
-----------------------------------------------------
Fax | 954-926-5804
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. ROLAND F. BESSIS
-----------------------------------------------------
Credential | PH.D.
-----------------------------------------------------
Telephone | 954-926-7486
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | PY0005053
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------