| Organization Name: | MANOR PLAZA PEDIATRIC CENTER INC |
| NPI Number: | 1558657130 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JEAN-WILNER MATHIEU (MEDICAL DIRECTOR) |
| Mailing Address: | 1234 Ne 4th Ave Fort Lauderdale |
| State: | FL US |
| Postal Code: | 333041925 |
| Phone Number: | 9547791667 |
| Fax Number: | 9547607253 |
| NPI Enumeration Date: | 06/22/2011 |
| NPI Last Update Date: | 02/16/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | ME0042195 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | FL |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |