NPIMap

Organization Active NPI

Path Medical, LLC

  • Clinic/Center
  • Miami Gardens, FL
National Provider Identifier
1083074595
Registry record updated Sep 9, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
PATH MEDICAL, LLC
Practice address
17560 NW 27TH Ave Ste 111
Miami Gardens, FL 33056-4075
Phone
(305) 623-5939
Fax
(305) 623-1541
NPI assigned
Feb 25, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 9, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Neil Bonnardel, MD
Title
Director of Medical Services
Phone
(754) 218-2164

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X Primary

Addresses

Primary practice location

17560 NW 27TH Ave Ste 111
Miami Gardens, FL 33056-4075

Mailing address

2304 W Oakland Park Blvd
Oakland Park, FL 33311-1422
Phone (754) 218-2164

Other names 1

  • Path Medical-Dade Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Path Medical LLC24 organizations share this tax ID, including this one

Other organizations with this tax ID 23

Organizations that report the same tax identification number in the National Provider Directory.

View all 23

Locations

17560 NW 27th Ave
Ste 111
Miami Gardens, FL 33056
Phone (305) 623-5939

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1456358400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1567987200000",
    "number": "1083074595",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2304 W OAKLAND PARK BLVD",
            "city": "OAKLAND PARK",
            "state": "FL",
            "postal_code": "333111422",
            "telephone_number": "754-218-2164"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17560 NW 27TH AVE STE 111",
            "city": "MIAMI GARDENS",
            "state": "FL",
            "postal_code": "330564075",
            "telephone_number": "305-623-5939",
            "fax_number": "305-623-1541"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PATH MEDICAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-02-25",
        "last_updated": "2019-09-09",
        "status": "A",
        "authorized_official_last_name": "BONNARDEL",
        "authorized_official_first_name": "NEIL",
        "authorized_official_title_or_position": "DIRECTOR OF MEDICAL SERVICES",
        "authorized_official_telephone_number": "754-218-2164",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Path Medical-Dade",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Path Medical-Dade",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Miami Gardens, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.