Organization
125TH STREET NM CORP
Active
Organization
125TH STREET NM CORP
Active
Other names
125th Street Medical and Urgent Care Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. IGOR NIZNIK (PRESIDENT/OWNER)
(786) 235-7240
Entity
Organization
Contact information
Practice address
505 NE 125TH ST, NORTH MIAMI, FL 33161-4718
(786) 235-7240
(786) 235-7241
Mailing address
505 NE 125TH ST, NORTH MIAMI, FL 33161-4718
(786) 235-7240
(786) 235-7241
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
PMC20
FL
Other
Enumeration date
11/30/2010
Last updated
11/30/2010
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