Provider Demographics
NPI:1174899082
Name:FLORIDA ADVANCED MEDICAL AND DERM AESTHETICS LLC
Entity type:Organization
Organization Name:FLORIDA ADVANCED MEDICAL AND DERM AESTHETICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANJAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-435-8011
Mailing Address - Street 1:13660 S JOG RD STE 1B
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33446-3806
Mailing Address - Country:US
Mailing Address - Phone:561-499-6622
Mailing Address - Fax:561-499-6795
Practice Address - Street 1:13660 S JOG RD STE 1B
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33446-3806
Practice Address - Country:US
Practice Address - Phone:561-499-6622
Practice Address - Fax:561-499-6795
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-25
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty