=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639365703
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ADMINISTRATIVE SERVICES OF FLORIDA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/21/2007
-----------------------------------------------------
Last Update Date | 09/21/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 901 N FLAGLER DR
-----------------------------------------------------
City | WEST PALM BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33401-3713
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-832-4411
-----------------------------------------------------
Fax | 561-832-1591
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 901 N FLAGLER DR
-----------------------------------------------------
City | WEST PALM BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33401-3713
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-832-4411
-----------------------------------------------------
Fax | 561-832-1591
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MBR
-----------------------------------------------------
Name | DR. LAUREN R ROSECAN
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 561-832-4411
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | ME0050469
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------