=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922794999
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FLORIDA MEN'S HEALTH CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/13/2023
-----------------------------------------------------
Last Update Date | 04/13/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 906 NE 26TH AVE
-----------------------------------------------------
City | FORT LAUDERDALE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33304-3607
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-584-7009
-----------------------------------------------------
Fax | 954-584-7209
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 906 NE 26TH AVE
-----------------------------------------------------
City | FORT LAUDERDALE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33304-3607
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-584-7009
-----------------------------------------------------
Fax | 954-584-7209
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | EREZ COHEN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 954-584-7009
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM1300X
-----------------------------------------------------
Taxonomy Name | Multi-Specialty Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------