Provider Demographics
NPI:1427247451
Name:NABIL S. ITANI DO PA
Entity type:Organization
Organization Name:NABIL S. ITANI DO PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:NABIL
Authorized Official - Middle Name:SAMIR
Authorized Official - Last Name:ITANI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:321-268-8787
Mailing Address - Street 1:875 CENTURY MEDICAL DR
Mailing Address - Street 2:
Mailing Address - City:TITUSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32796-2142
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:321-383-2424
Practice Address - Street 1:875 CENTURY MEDICAL DR
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32796-2142
Practice Address - Country:US
Practice Address - Phone:321-268-8787
Practice Address - Fax:321-383-2424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-16
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS9008207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
I00937Medicare UPIN
K5253Medicare PIN