Provider Demographics
NPI:1063170124
Name:MINDFUL MEDICINE LLC
Entity type:Organization
Organization Name:MINDFUL MEDICINE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/ MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:PESKIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:216-973-2844
Mailing Address - Street 1:7000 W PALMETTO PARK RD STE 406
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-3425
Mailing Address - Country:US
Mailing Address - Phone:844-986-4325
Mailing Address - Fax:
Practice Address - Street 1:7000 W PALMETTO PARK RD STE 406
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-3425
Practice Address - Country:US
Practice Address - Phone:844-986-4325
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-06
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)