Provider Demographics
NPI:1992303812
Name:NEIGHBORMD OF KISSIMMEE LLC
Entity type:Organization
Organization Name:NEIGHBORMD OF KISSIMMEE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:ROMANELLO
Authorized Official - Suffix:
Authorized Official - Credentials:COO
Authorized Official - Phone:352-459-3661
Mailing Address - Street 1:595 OAK COMMONS BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-4211
Mailing Address - Country:US
Mailing Address - Phone:321-249-6954
Mailing Address - Fax:
Practice Address - Street 1:595 OAK COMMONS BLVD STE A
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-4211
Practice Address - Country:US
Practice Address - Phone:321-249-6954
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-13
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty