Provider Demographics
NPI:1124058334
Name:PANDYA KING GROUP PA
Entity type:Organization
Organization Name:PANDYA KING GROUP PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SUNIL
Authorized Official - Middle Name:RAMESH
Authorized Official - Last Name:PANDYA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-287-0798
Mailing Address - Street 1:PO BOX 161557
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33116-1557
Mailing Address - Country:US
Mailing Address - Phone:239-513-0363
Mailing Address - Fax:239-513-7923
Practice Address - Street 1:1656 MEDICAL BLVD
Practice Address - Street 2:STE 302
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34110-1423
Practice Address - Country:US
Practice Address - Phone:239-513-0363
Practice Address - Fax:239-513-7923
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK8153Medicare ID - Type UnspecifiedGROUP NUMBER