Pembrok Health and Wellness Center, LLC

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

FLOS4139 Issued in FL

Legal business name

PEMBROK HEALTH AND WELLNESS CENTER, LLC

Practice address

12133 Pembroke Road
Pembroke Pines, FL 33025

Phone

(954) 499-4143

Fax

(954) 499-4146

NPI assigned

Oct 22, 2010

Organization subpart

No

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

Authorized official

Name

Dr. Mark Dean Kornhaber, DO

Title

Medical Director

Phone

(954) 499-4143

Specialties & licenses 2

Addresses

Tax ID family

Atlantic Pain Rehab LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• Atlantic Pain & Rehab LLC

  • Legal Medicine
  • Pembroke Pines, FL
  • NPI 1477861896
  NPD tax ID

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

{
    "created_epoch": "1287705600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1287705600000",
    "number": "1548560733",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12133 PEMBROKE ROAD",
            "city": "PEMBROKE PINES",
            "state": "FL",
            "postal_code": "33025",
            "telephone_number": "954-499-4143",
            "fax_number": "954-499-4146"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12133 PEMBROKE ROAD",
            "city": "PEMBROKE PINES",
            "state": "FL",
            "postal_code": "33025",
            "telephone_number": "954-499-4143",
            "fax_number": "954-499-4146"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEMBROK HEALTH AND WELLNESS CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-10-22",
        "last_updated": "2010-10-22",
        "status": "A",
        "authorized_official_last_name": "KORNHABER",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "DEAN",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "954-499-4143",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": "FL",
            "license": "FLOS4139",
            "primary": true
        },
        {
            "code": "208VP0014X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": "FL",
            "license": "FLOS4139",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dolia Peguero, LCSW
• Ashley Pelaez, RD
• Sophia Pelaez
• Melissa Rae Pelosi, PA
• Pemboke Family Denisty P.a.
• Pembroke Dental & Spa PL
• Pembroke Dental Associates
• Pembroke Lakes Mall Dental PA
• Pembroke Lakes Optical Inc
• Pembroke Pavilion Psychiatric Associates, Inc

• General Practice Physician in Pembroke Pines, FL
• Providers in Pembroke Pines, FL by specialty
• General Practice Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2010; 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.