| Organization Name: | 53RD STREET MEDICAL GROUP, LLC |
| NPI Number: | 1962767202 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | KAREN BARLOW (PRESIDENT, JUPITER PROFESSIONAL DEV) |
| Mailing Address: | 2331 Ne 53rd St Ft Lauderdale |
| State: | FL US |
| Postal Code: | 333083235 |
| Phone Number: | 9544919700 |
| Fax Number: | |
| NPI Enumeration Date: | 07/12/2012 |
| NPI Last Update Date: | 08/01/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2084A0401X |
| License Number: | ME83014 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Psychiatry & Neurology |
| Taxonomy Specialization: | Addiction Medicine |
| Taxonomy Definition: | A doctor of osteopathy board eligible/certified in the field of Psychiatry by the American Osteopathic Board of Neurology and Psychiatry is able to obtain a Certificate of Added Qualifications in the field of Addiction Medicine |