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General NPI Number Information
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NPI Number | 1679807770
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Entity Type | Organization
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Legal Business Name | INSIGHT PROVIDER GROUP, INC
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Dates
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Enumeration Date | 09/23/2009
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Last Update Date | 09/23/2009
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Provider Practice Location Address
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Address Line | 1727 BANKS RD
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City | MARGATE
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State | FL
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Zip | 33063-7744
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Country | US
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Telephone | 954-366-2600
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Fax | 954-366-2056
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Provider Business Mailing Address
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Address Line | 1727 BANKS RD
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City | MARGATE
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State | FL
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Zip | 33063-7744
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Country | US
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Telephone | 954-366-2600
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Fax | 954-366-2056
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. ALAN DURETZ
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Credential |
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Telephone | 954-366-2600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2084P0805X
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Taxonomy Name | Geriatric Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 364SP0813X
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Taxonomy Name | Geropsychiatric Psychiatric/Mental Health Clinical Nurse Specialist
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License Number |
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License Number State |
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