Preservation Park Emergency Physicians, LLC

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

Legal business name

PRESERVATION PARK EMERGENCY PHYSICIANS, LLC

Practice address

10921 S Jog Rd Ste 156
Boynton Beach, FL 33437-4002

Phone

(561) 548-8250

NPI assigned

Jun 15, 2021

Organization subpart

No

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

Authorized official

Name

Kathleen Marie Kondas

Title

Ao

Phone

(973) 251-1132

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1623715200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1623715200000",
    "number": "1144898321",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5565 CENTERVIEW DR STE 107",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276063563",
            "telephone_number": "973-251-1132"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10921 S JOG RD STE 156",
            "city": "BOYNTON BEACH",
            "state": "FL",
            "postal_code": "334374002",
            "telephone_number": "561-548-8250"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRESERVATION PARK EMERGENCY PHYSICIANS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-06-15",
        "last_updated": "2021-06-15",
        "certification_date": "2021-06-15",
        "status": "A",
        "authorized_official_last_name": "KONDAS",
        "authorized_official_first_name": "KATHLEEN",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "AO",
        "authorized_official_telephone_number": "973-251-1132"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Emergency Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2021; 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.