# 125TH STREET NM CORP

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- **Entity:** Organization
- **Status:** Active
- **Other names:** 125th Street Medical and Urgent Care Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1255633046
- **Authorized official:** MR. IGOR NIZNIK (PRESIDENT/OWNER)
- **Authorized official phone:** (786) 235-7240

## Contact information

- **Practice address:** 505 NE 125TH ST, NORTH MIAMI, FL 33161-4718
- **Practice address phone:** (786) 235-7240
- **Practice address fax:** (786) 235-7241
- **Mailing address:** 505 NE 125TH ST, NORTH MIAMI, FL 33161-4718
- **Mailing address phone:** (786) 235-7240
- **Mailing address fax:** (786) 235-7241

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM1300X | Multi-Specialty Clinic/Center | PMC20 | FL | Yes |

## Other

- **Enumeration date:** 11/30/2010
- **Last updated:** 11/30/2010