Provider Demographics
NPI:1053368845
Name:SASSOON, EDDIE E (MD)
Entity type:Individual
Prefix:
First Name:EDDIE
Middle Name:E
Last Name:SASSOON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10011 PINES BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33024-6189
Mailing Address - Country:US
Mailing Address - Phone:954-748-7474
Mailing Address - Fax:954-748-7772
Practice Address - Street 1:10011 PINES BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33024-6189
Practice Address - Country:US
Practice Address - Phone:954-748-7474
Practice Address - Fax:954-748-7772
Is Sole Proprietor?:No
Enumeration Date:2006-05-28
Last Update Date:2012-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA57648208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL55940700Medicaid
FLA63949Medicare UPIN
FL07980XMedicare ID - Type Unspecified