=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659300887
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ELIE DUMENY JR. M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/01/2006
-----------------------------------------------------
Last Update Date | 01/31/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 599 S FEDERAL HWY STE 104
-----------------------------------------------------
City | DANIA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33004-4175
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-927-2752
-----------------------------------------------------
Fax | 954-927-6701
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 599 S FEDERAL HWY STE 104
-----------------------------------------------------
City | DANIA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33004-4175
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-927-2752
-----------------------------------------------------
Fax | 954-927-6701
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | ME69459
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number | ME69459
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------