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General NPI Number Information
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NPI Number | 1265822340
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Entity Type | Organization
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Legal Business Name | JORDAN FABRIKANT, D.O., P.A.
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Dates
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Enumeration Date | 01/28/2015
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Last Update Date | 01/28/2015
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Provider Practice Location Address
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Address Line | 6140 SW 70TH ST SECOND FLOOR
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City | SOUTH MIAMI
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State | FL
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Zip | 33143-3419
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Country | US
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Telephone | 305-284-7577
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Fax | 305-675-3714
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Provider Business Mailing Address
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Address Line | 6140 SW 70TH ST SECOND FLOOR
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City | SOUTH MIAMI
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State | FL
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Zip | 33143-3419
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Country | US
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Telephone | 305-284-7577
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Fax | 305-675-3714
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. JORDAN S FABRIKANT
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Credential | D.O
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Telephone | 305-284-7742
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number |
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License Number State |
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