Banyan2
Clinic/Center, Primary Care in Miami Lakes, FL. Organization (NPI-2).
NPI number1629316070
StatusActive
Last updated in NPPESJan 18, 2013
Details
- NPI
- 1629316070
- Entity type
- Organization (NPI-2)
- Legal business name
- Banyan2
- Organization subpart
- No
- Enumeration date
- Jan 18, 2013
- Last updated
- Jan 18, 2013
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QP2300X | Clinic/Center, Primary Care | – | – | Yes |
| 261QH0100X | Clinic/Center, Health Services | – | – |
Practice location
6175 Nw 153rd StSuite 332
Miami Lakes, FL 33014-2435
Phone 305-663-5696
Mailing address
6619 S Dixie HwySuite 229
Miami, FL 33143-7919
Authorized official
Justin Newman
Medical Director
3056635696
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