Provider Demographics
NPI:1053750661
Name:R GASTESI, MD PA
Entity type:Organization
Organization Name:R GASTESI, MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GASTESI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-298-1273
Mailing Address - Street 1:2780 N FEDERAL HWY
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33306-1424
Mailing Address - Country:US
Mailing Address - Phone:954-564-1111
Mailing Address - Fax:
Practice Address - Street 1:2780 N FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33306-1424
Practice Address - Country:US
Practice Address - Phone:954-564-1111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-17
Last Update Date:2013-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0017960261QX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0200XAmbulatory Health Care FacilitiesClinic/CenterOncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL93340Medicare UPIN