Provider Demographics
NPI:1548258700
Name:SEKINE RASNER BROCK MD PA
Entity type:Organization
Organization Name:SEKINE RASNER BROCK MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:HANNAH
Authorized Official - Last Name:LENTO
Authorized Official - Suffix:
Authorized Official - Credentials:BSH, CMPE
Authorized Official - Phone:904-262-5333
Mailing Address - Street 1:PO BOX 17399
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32245-7399
Mailing Address - Country:US
Mailing Address - Phone:904-262-5333
Mailing Address - Fax:904-262-5337
Practice Address - Street 1:11945 SAN JOSE BLVD STE 400
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32223-1627
Practice Address - Country:US
Practice Address - Phone:904-262-5333
Practice Address - Fax:904-262-5337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-12
Last Update Date:2009-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL374785900Medicaid
FLK2288Medicare UPIN