=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942483987
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FARKAS ENTERPRISES FOOT & ANKLE SPORTS MEDICINE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/13/2007
-----------------------------------------------------
Last Update Date | 01/25/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1001 N FEDERAL HWY SUITE101
-----------------------------------------------------
City | HALLANDALE BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33009-2400
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-454-6743
-----------------------------------------------------
Fax | 954-454-6836
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1001 N FEDERAL HWY SUITE101
-----------------------------------------------------
City | HALLANDALE BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33009-2400
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-454-6743
-----------------------------------------------------
Fax | 954-454-6836
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DANIELA MARINAU FARKAS
-----------------------------------------------------
Credential | DPM
-----------------------------------------------------
Telephone | 954-454-6743
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213EP1101X
-----------------------------------------------------
Taxonomy Name | Primary Podiatric Medicine Podiatrist
-----------------------------------------------------
License Number | PO2957
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------