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General NPI Number Information
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NPI Number | 1841484029
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Entity Type | Organization
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Legal Business Name | MOISES SIPERSTEIN MD PA
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Dates
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Enumeration Date | 08/30/2007
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Last Update Date | 12/22/2014
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Provider Practice Location Address
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Address Line | 10377 S US HIGHWAY 1 SUITE 102
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City | PORT ST LUCIE
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State | FL
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Zip | 34952-5630
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Country | US
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Telephone | 772-337-7811
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Fax | 772-337-7833
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Provider Business Mailing Address
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Address Line | 10377 S US HIGHWAY 1 SUITE 102
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City | PORT ST LUCIE
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State | FL
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Zip | 34952-5630
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Country | US
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Telephone | 772-337-7811
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Fax | 772-337-7833
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MOISES SIPERSTEIN-BLUMOVICZ
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Credential | M.D.
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Telephone | 772-337-7811
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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 | ME76469
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License Number State | FL
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