Provider Demographics
NPI:1073244190
Name:MEDICAL & CO. LLC
Entity type:Organization
Organization Name:MEDICAL & CO. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MGRM
Authorized Official - Prefix:
Authorized Official - First Name:SIMON
Authorized Official - Middle Name:EMMANUEL
Authorized Official - Last Name:SHOSHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-570-9234
Mailing Address - Street 1:250 95TH ST UNIT 545951
Mailing Address - Street 2:
Mailing Address - City:SURFSIDE
Mailing Address - State:FL
Mailing Address - Zip Code:33154-2820
Mailing Address - Country:US
Mailing Address - Phone:786-570-9234
Mailing Address - Fax:
Practice Address - Street 1:417 NW 2ND AVE STE 1A
Practice Address - Street 2:
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-3302
Practice Address - Country:US
Practice Address - Phone:786-570-9234
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-20
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory