MEDICARE: WINDOW PANE PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1619683885
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WINDOW PANE PA

Provider Business Mailing Address
First Line	:	5630 BROOKFIELD CIR E
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33312-6256
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5630 BROOKFIELD CIR E
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33312-6256
Country	:	US
Telephone Number	:	800-555-1212
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SIMON FENSTERSZAUB
Credential	:	DO
Telephone Number	:	800-555-1212

Provider Enumeration Date	:	01/30/2023
Last Update Date	:	02/15/2023

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Directions to “WINDOW PANE PA ” Practice Location

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