Provider Demographics
NPI:1053095265
Name:ADVANCED PEDIATRIC PULMONOLOGY, PLLC
Entity type:Organization
Organization Name:ADVANCED PEDIATRIC PULMONOLOGY, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:MYRTHA
Authorized Official - Last Name:GREGOIRE-BOTTEX
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-462-7411
Mailing Address - Street 1:2701 BISCAYNE BLVD APT 7102
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33137-5302
Mailing Address - Country:US
Mailing Address - Phone:914-462-7411
Mailing Address - Fax:
Practice Address - Street 1:1971 SW 172ND AVE STE 3128
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33029-5592
Practice Address - Country:US
Practice Address - Phone:954-299-5272
Practice Address - Fax:855-583-3365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-09
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0214XAllopathic & Osteopathic PhysiciansPediatricsPediatric PulmonologyGroup - Single Specialty
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical SpecialtyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL102074500Medicaid
FL10D2296465OtherCLIA
FL00118945800Medicaid
FL2HXM4OtherFLORIDA BLUE PROVIDER
11995072OtherCAQH
FL1J6FXOtherFLORIDA BLUE