| Ezra Medical Llc | |
|
1780 Polk St Fl 11 Suite D Hollywood FL 33020-4611 | |
| (917) 509-2538 | |
| Not Available |
| Full Name | Ezra Medical Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 1780 Polk St Fl 11, Hollywood, Florida |
| Authorized Official Name and Position | Isaac Soskin (MEMBER) |
| Authorized Official Contact | 9175092538 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ezra Medical Llc 1780 Polk St Fl 11 Hollywood FL 33020-4611 Ph: () - | Ezra Medical Llc 1780 Polk St Fl 11 Suite D Hollywood FL 33020-4611 Ph: (917) 509-2538 |
| NPI Number | 1285404962 |
|---|---|
| Provider Enumeration Date | 01/04/2024 |
| Last Update Date | 01/04/2024 |
| Medicare PECOS PAC ID | 1355787110 |
|---|---|
| Medicare Enrollment ID | O20240314003382 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1285404962 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Elty Aprn Chirolde Pimienta |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1205411071 PECOS PAC ID: 7719335827 Enrollment ID: I20231130001408 |
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