| NPI | 1710603550 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALEXANDER PUSHKA Owner 954-579-1110 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry |
| Additional Taxonomies | 2084P0804X Psychiatry & Neurology Child & Adolescent Psychiatry |
| 2084P0805X Psychiatry & Neurology Geriatric Psychiatry | |
| 363LP0808X Nurse Practitioner Psychiatric/Mental Health | |
| 364SP0808X Clinical Nurse Specialist Psychiatric/Mental Health | |
| Enumeration Date | 2022-10-13 |
| Last Update Date | 2024-10-04 |