Provider Demographics
NPI:1679593883
Name:QUALITY MEDICAL ASSOCIATION OF WEST DELRAY INC
Entity type:Organization
Organization Name:QUALITY MEDICAL ASSOCIATION OF WEST DELRAY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STUART
Authorized Official - Middle Name:BENSON
Authorized Official - Last Name:HIMMELSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-495-9292
Mailing Address - Street 1:5258 LINTON BLVD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33484-6540
Mailing Address - Country:US
Mailing Address - Phone:561-495-9292
Mailing Address - Fax:561-495-0221
Practice Address - Street 1:5258 LINTON BLVD
Practice Address - Street 2:SUITE 206
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33484-6540
Practice Address - Country:US
Practice Address - Phone:561-495-9292
Practice Address - Fax:561-495-0221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2008-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0059597207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAM339Medicare PIN