=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316052285
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MIAMI BEACH PEDIATRICS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/20/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 524 ARTHUR GODFREY RD STE 201
-----------------------------------------------------
City | MIAMI BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33140-3528
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-672-7337
-----------------------------------------------------
Fax | 305-672-6555
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 524 ARTHUR GODFREY RD STE 201
-----------------------------------------------------
City | MIAMI BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33140-3528
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-672-7337
-----------------------------------------------------
Fax | 305-672-6555
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. BRUCE NILES EISENBERG
-----------------------------------------------------
Credential | M.D
-----------------------------------------------------
Telephone | 305-672-7337
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | ME0056607
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------