Provider Demographics
NPI:1902906167
Name:APPLEBAUM, NEIL A (PSYD)
Entity Type:Individual
Prefix:DR
First Name:NEIL
Middle Name:A
Last Name:APPLEBAUM
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 N. HIATUS ROAD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33026-6034
Mailing Address - Country:US
Mailing Address - Phone:954-441-5130
Mailing Address - Fax:954-441-5129
Practice Address - Street 1:1000 N. HIATUS ROAD
Practice Address - Street 2:SUITE 110
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33026-3094
Practice Address - Country:US
Practice Address - Phone:954-441-5130
Practice Address - Fax:954-441-5129
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2013-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 4282103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL73606Medicare ID - Type Unspecified