Provider Demographics
NPI:1316146947
Name:LAURA J. ZALCBERG M.D. PA
Entity type:Organization
Organization Name:LAURA J. ZALCBERG M.D. PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:JUDITH
Authorized Official - Last Name:ZALCBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-714-4685
Mailing Address - Street 1:2951 NW 49TH AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:LAUDERDALE LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33313-1638
Mailing Address - Country:US
Mailing Address - Phone:954-714-4685
Mailing Address - Fax:954-714-5864
Practice Address - Street 1:2951 NW 49TH AVE STE 102
Practice Address - Street 2:
Practice Address - City:LAUDERDALE LAKES
Practice Address - State:FL
Practice Address - Zip Code:33313-1638
Practice Address - Country:US
Practice Address - Phone:954-714-4685
Practice Address - Fax:954-714-5864
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-13
Last Update Date:2008-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME79608174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL259125100Medicaid
FL259125100Medicaid
FLH15326Medicare UPIN