=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407101876
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ELLEN BABINSKY DO PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/20/2012
-----------------------------------------------------
Last Update Date | 01/21/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3060 MELALEUCA LN
-----------------------------------------------------
City | LAKE WORTH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33461-5174
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-376-6277
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 678304
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75267-8304
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-376-6277
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | ELLEN BABINSKY
-----------------------------------------------------
Credential | DO
-----------------------------------------------------
Telephone | 516-376-6277
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208100000X
-----------------------------------------------------
Taxonomy Name | Physical Medicine & Rehabilitation Physician
-----------------------------------------------------
License Number | OS 10668
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------