NPIMap

Organization Active NPI

Northlake Medical

  • Clinic/Center
  • Lake Park, FL
National Provider Identifier
1568635233
Registry record updated Jul 14, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
NORTHLAKE MEDICAL
Practice address
3450 Northlake Blvd
Lake Park, FL 33403
Phone
(561) 627-8602
Fax
(561) 627-8603
NPI assigned
Apr 2, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 14, 2008

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

Authorized official

Name
Daniel Albert FortunatoNPI 1568596344
Title
President
Phone
(561) 627-8602

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X Primary

Addresses

Primary practice location

3450 Northlake Blvd
Lake Park, FL 33403

Mailing address

3450 Northlake Blvd
Lake Park, FL 33403
Phone (561) 627-8602

Other names 1

  • Chiropractic & Rehabilitation Other name

National Provider Directory

National Provider Directory

Locations

3450 Northlake Blvd
Palm Beach Gardens, FL 33403
Phone (561) 625-2775

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1207094400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1215993600000",
    "number": "1568635233",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3450 NORTHLAKE BLVD",
            "city": "LAKE PARK",
            "state": "FL",
            "postal_code": "33403",
            "telephone_number": "561-627-8602",
            "fax_number": "561-627-8603"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3450 NORTHLAKE BLVD",
            "city": "LAKE PARK",
            "state": "FL",
            "postal_code": "33403",
            "telephone_number": "561-627-8602",
            "fax_number": "561-627-8603"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHLAKE MEDICAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-02",
        "last_updated": "2008-07-14",
        "status": "A",
        "authorized_official_last_name": "FORTUNATO",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_middle_name": "ALBERT",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "561-627-8602"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Chiropractic & Rehabilitation",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Lake Park, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2008; 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.