53Rd Street Medical Group, LLC

Primary specialty

Addiction Medicine (Psychiatry & Neurology) PhysicianTaxonomy code 2084A0401X

License

ME83014 Issued in FL

Legal business name

53RD STREET MEDICAL GROUP, LLC

Practice address

2331 NE 53Rd St
Ft Lauderdale, FL 33308-3235

Phone

(954) 491-9700

NPI assigned

Jul 12, 2012

Organization subpart

No

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

Authorized official

Name

Karen Barlow

Title

President, Jupiter Professional Dev

Phone

(561) 748-2889

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1342051200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1343779200000",
    "number": "1962767202",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7240",
            "city": "JUPITER",
            "state": "FL",
            "postal_code": "334687240",
            "telephone_number": "561-748-2889",
            "fax_number": "561-748-1523"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2331 NE 53RD ST",
            "city": "FT LAUDERDALE",
            "state": "FL",
            "postal_code": "333083235",
            "telephone_number": "954-491-9700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "53RD STREET MEDICAL GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-07-12",
        "last_updated": "2012-08-01",
        "status": "A",
        "authorized_official_last_name": "BARLOW",
        "authorized_official_first_name": "KAREN",
        "authorized_official_title_or_position": "PRESIDENT, JUPITER PROFESSIONAL DEV",
        "authorized_official_telephone_number": "561-748-2889"
    },
    "taxonomies": [
        {
            "code": "2084A0401X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Addiction Medicine",
            "state": "FL",
            "license": "ME83014",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Addiction Medicine (Psychiatry & Neurology) Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2012; 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.