Provider Demographics
NPI:1174068043
Name:ANDROGENIX LLC
Entity type:Organization
Organization Name:ANDROGENIX LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWENER
Authorized Official - Prefix:
Authorized Official - First Name:ZACHARY
Authorized Official - Middle Name:
Authorized Official - Last Name:BREAKEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-801-2949
Mailing Address - Street 1:401 NORTHLAKE BLVD
Mailing Address - Street 2:STE 7
Mailing Address - City:NORTH PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33408-5428
Mailing Address - Country:US
Mailing Address - Phone:561-801-2949
Mailing Address - Fax:877-318-8114
Practice Address - Street 1:401 NORTHLAKE BLVD
Practice Address - Street 2:STE 7
Practice Address - City:NORTH PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33408-5428
Practice Address - Country:US
Practice Address - Phone:561-801-2949
Practice Address - Fax:877-318-8114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-30
Last Update Date:2016-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN175F00000X
FLME83309207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Multi-Specialty
No175F00000XOther Service ProvidersNaturopathGroup - Multi-Specialty