Provider Demographics
NPI:1548031735
Name:USLAR MEDICAL FL PA
Entity type:Organization
Organization Name:USLAR MEDICAL FL PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LIUBOU
Authorized Official - Middle Name:
Authorized Official - Last Name:USLAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-712-6539
Mailing Address - Street 1:446 GRAND AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:LEONIA
Mailing Address - State:NJ
Mailing Address - Zip Code:07605-2299
Mailing Address - Country:US
Mailing Address - Phone:617-712-6539
Mailing Address - Fax:
Practice Address - Street 1:2500 E HALLANDALE BEACH BLVD STE 611
Practice Address - Street 2:
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-4839
Practice Address - Country:US
Practice Address - Phone:617-712-6539
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-16
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty