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General NPI Number Information
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NPI Number | 1265959357
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Entity Type | Organization
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Legal Business Name | FLORIDA MAT PHYSICIANS, LLC
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Dates
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Enumeration Date | 08/29/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 3113 STIRLING RD STE 103
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City | FORT LAUDERDALE
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State | FL
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Zip | 33312-6547
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Country | US
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Telephone | 954-995-3805
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Fax |
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Provider Business Mailing Address
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Address Line | 3113 STIRLING RD STE 103
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City | FORT LAUDERDALE
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State | FL
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Zip | 33312-6547
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Country | US
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Telephone | 954-995-3805
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | SAMUEL ROGATINSKY
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Credential |
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Telephone | 954-995-3805
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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