Florida Medical and Diagnostic Center

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

Legal business name

FLORIDA MEDICAL AND DIAGNOSTIC CENTER

Doing business as

Florida Medical and Diagnostic Center

Practice address

3020 NE 32ND Ave Ste 305
Fort Lauderdale, FL 33308-7204

Phone

(954) 302-3048

Fax

(718) 554-1666

NPI assigned

Jun 19, 2019

Last updated

Jun 19, 2019By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Bogomolova Yulia

Title

Medical Director

Phone

(954) 302-3048

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• FLORIDA MEDICAL AND DIAGNOSTIC CENTER Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Alexander Eugene Istomin MD, MD, MS, MS

  • Internal Medicine Physician
  • Elmhurst, NY
  • NPI 1235185778

  Nurse Practitioner

  NPD

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

{
    "created_epoch": "1560902400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1560902400000",
    "number": "1942860093",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3020 NE 32ND AVE STE 305",
            "city": "FORT LAUDERDALE",
            "state": "FL",
            "postal_code": "333087204",
            "telephone_number": "954-302-3048",
            "fax_number": "718-554-1666"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3020 NE 32ND AVE STE 305",
            "city": "FORT LAUDERDALE",
            "state": "FL",
            "postal_code": "333087204",
            "telephone_number": "954-302-3048",
            "fax_number": "718-554-1666"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FLORIDA MEDICAL AND DIAGNOSTIC CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-06-19",
        "last_updated": "2019-06-19",
        "status": "A",
        "authorized_official_last_name": "YULIA",
        "authorized_official_first_name": "BOGOMOLOVA",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "954-302-3048",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LIC",
            "identifier": "9238727",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "FLORIDA MEDICAL AND DIAGNOSTIC CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Florida Men's Health Center
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• Florida Neuroscience L L C (Florida Neuroscience Center)

• Nurse Practitioner in Fort Lauderdale, FL
• Providers in Fort Lauderdale, FL by specialty
• Nurse Practitioner in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 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.