Provider Demographics
NPI:1851324008
Name:STREET, ESTHER
Entity type:Individual
Prefix:MRS
First Name:ESTHER
Middle Name:
Last Name:STREET
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11054 S MILITARY TRL
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33436-7217
Mailing Address - Country:US
Mailing Address - Phone:561-364-2600
Mailing Address - Fax:561-364-2199
Practice Address - Street 1:11054 S MILITARY TRL
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33436-7217
Practice Address - Country:US
Practice Address - Phone:561-364-2600
Practice Address - Fax:561-364-2199
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1644332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL5435890001Medicare NSC