Leavitt Medical Associates of Florida Inc

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

LEAVITT MEDICAL ASSOCIATES OF FLORIDA INC

Doing business as

Advanced Dermatology and Cosmetic Surgery

Practice address

6100 Glades Rd
Suite 304
Boca Raton, FL 33434-4325

Phone

(561) 488-2689

Fax

(561) 826-1881

NPI assigned

May 30, 2008

Last updated

Apr 21, 2010By the provider in NPPES

Organization subpart

Yes

Parent organization

LEAVITT MEDICAL ASSOCIATES OF FLORIDA INCAs reported in NPPES

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

Authorized official

Name

Nefrita Logan

Title

Pro Ser Rep

Phone

(407) 875-2080

Specialties & licenses 4

Addresses

Other names 1

• Advanced Dermatology and Cosmetic Surgery Doing business as

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Part of

Leavitt Med Aso of FL Inc

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

{
    "created_epoch": "1212105600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1271808000000",
    "number": "1295993772",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2600 LAKE LUCIEN DR",
            "address_2": "SUITE 180",
            "city": "MAITLAND",
            "state": "FL",
            "postal_code": "327517233",
            "telephone_number": "407-875-2080",
            "fax_number": "407-875-0518"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6100 GLADES RD",
            "address_2": "SUITE 304",
            "city": "BOCA RATON",
            "state": "FL",
            "postal_code": "334344325",
            "telephone_number": "561-488-2689",
            "fax_number": "561-826-1881"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEAVITT MEDICAL ASSOCIATES OF FLORIDA INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LEAVITT MEDICAL ASSOCIATES OF FLORIDA INC",
        "enumeration_date": "2008-05-30",
        "last_updated": "2010-04-21",
        "status": "A",
        "authorized_official_last_name": "LOGAN",
        "authorized_official_first_name": "NEFRITA",
        "authorized_official_title_or_position": "PRO SER REP",
        "authorized_official_telephone_number": "407-875-2080"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208200000X",
            "taxonomy_group": "",
            "desc": "Plastic Surgery",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Advanced Dermatology and Cosmetic Surgery",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Leavitt Medical Associates of Florida Inc (Advanced Dermatology and Cosmectic Surgery)
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• Sandra M Leber, OTR
• Suzanne Denise Leblang, MD

• Dermatology Physician in Boca Raton, FL
• Providers in Boca Raton, FL by specialty
• Dermatology Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.