Provider Demographics
NPI:1285768416
Name:GARDENS EKG ASSOCIATES
Entity type:Organization
Organization Name:GARDENS EKG ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ELAINE
Authorized Official - Middle Name:C
Authorized Official - Last Name:HINES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-747-5735
Mailing Address - Street 1:PO BOX 8063
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33468-8063
Mailing Address - Country:US
Mailing Address - Phone:561-747-5735
Mailing Address - Fax:561-743-3359
Practice Address - Street 1:4700 N CONGRESS AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407-3282
Practice Address - Country:US
Practice Address - Phone:561-747-5735
Practice Address - Fax:561-743-3359
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL82197YOtherDR RAVITSKY BCBS PR #
FL82670XOtherDR HANNEY BCBS PR #
FL0527271-00Medicaid
FLD27353Medicare UPIN
FL0527271-00Medicaid
FL82670XOtherDR HANNEY BCBS PR #