Provider Demographics
NPI:1497043400
Name:MOSAIC MEDICAL, P.C.
Entity type:Organization
Organization Name:MOSAIC MEDICAL, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RICK
Authorized Official - Middle Name:
Authorized Official - Last Name:ROMOLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-538-4047
Mailing Address - Street 1:PO BOX 781299
Mailing Address - Street 2:
Mailing Address - City:SEBASTIAN
Mailing Address - State:FL
Mailing Address - Zip Code:32978-1299
Mailing Address - Country:US
Mailing Address - Phone:772-581-6226
Mailing Address - Fax:
Practice Address - Street 1:4738 BROADWAY
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10040-1103
Practice Address - Country:US
Practice Address - Phone:800-853-4570
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-12
Last Update Date:2011-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty