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General NPI Number Information
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NPI Number | 1609486778
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Entity Type | Organization
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Legal Business Name | LIFETIME MEDICAL ASSOCIATES OF AVENTURA
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Dates
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Enumeration Date | 08/04/2020
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Last Update Date | 03/24/2025
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Provider Practice Location Address
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Address Line | 21097 NE 27TH CT STE 300
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City | AVENTURA
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State | FL
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Zip | 33180-1206
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Country | US
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Telephone | 305-409-0197
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Fax |
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Provider Business Mailing Address
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Address Line | 21097 NE 27TH CT STE 300
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City | AVENTURA
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State | FL
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Zip | 33180-1206
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Country | US
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Telephone | 786-244-2700
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Fax | 800-980-3761
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Authorized Official
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Title or Position | OWNER
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Name | STACY D ROSKIN
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Credential | MD
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Telephone | 305-409-0197
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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