Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 57648 | MA |
NPI | 1053368845 |
---|---|
Provider Name | Eddie E Sassoon |
First Address | Pembroke Pines, FL 33024-6189 |
Second Address | Pembroke Pines, FL 33024-6189 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/05/2006 |
Last Update Date | 14/09/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
55940700 | (05) | FL |
A63949 | (02) | FL |