SCOTT HOWARD DECKELBAUM


Address: 603 N Flamingo Rd Ste 350, Pembroke Pines, FL 33028-1013
Phone: 9544355100

SCOTT HOWARD DECKELBAUM (NPI# 1730100892) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1730100892
Entity Type Individual
Full Name SCOTT HOWARD DECKELBAUM
Credential DO
Practice Address 603 N Flamingo Rd Ste 350
Pembroke Pines
FL 33028-1013
Mailing Address 15051 S Tamiami Trl Ste 203
Fort Myers
FL 33908-5182
Practice Telephone 9544355100
Practice Fax Number 9543851533
Mailing Telephone 2394378810
Mailing Fax Number 2393132555
Enumeration Date 2006-07-22
Last Update Date 2018-02-28
Gender Code M
Is Sole Proprietor N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
N 207N00000X Dermatology 235559 NY Allopathic & Osteopathic Physicians
N 207N00000X Dermatology 5176 OK Allopathic & Osteopathic Physicians
N 207N00000X Dermatology 20A10789 CA Allopathic & Osteopathic Physicians
Y 207ND0101X Dermatology
Specialization: MOHS-Micrographic Surgery
OS14334 FL Allopathic & Osteopathic Physicians
N 207Q00000X Family Medicine 5176 OK Allopathic & Osteopathic Physicians
N 207Q00000X Family Medicine 20A10789 CA Allopathic & Osteopathic Physicians
N 207Q00000X Family Medicine 235559-1 NY Allopathic & Osteopathic Physicians

Other Provider Identifier

State Issuer Identifier Type Code
NY 02806417 05

Provider Secondary Practice Location

Address Telephone Number Fax Number
250 Delaware Ave, Suite 207, Delmar, NY 120541401 5186900789 5186410098

Office Location

Street Address 603 N FLAMINGO RD STE 350
City PEMBROKE PINES
State FL
Zip Code 33028-1013

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1821570276 Grace Olivine Lue Nurse Practitioner 2291 Nw 171 Terrace, Pembroke Pines, FL 33028 2018-09-02
1336658194 Edna Daniel Registered Nurse 16213 Nw 18th Street, Pembroke Pines, FL 33028 2017-09-25
1093257032 Carlos Eduardo Florian Jr. Physical Therapist 701 North Flamingo Road, Pembroke Pines, FL 33028 2016-11-08
1760868574 Clara Elisa Delgado Nurse Practitioner 601 N Flamingo Road Suite 105, Pembroke Pines, FL 33028 2015-08-04
1942614375 Emmanuel Magboo Physical Therapist 1563 Nw 159 Lane, Pembroke Pines, FL 33028 2014-06-13
1134546302 Tahnie Danastor Obstetrics & Gynecology 601 N Flamingo Rd Ste 307, Pembroke Pines, FL 33028 2014-03-25
1316388200 Mirella Silva-bass Counselor 2250 Nw 136 Ave # 100f, Pembroke Pines, FL 33028 2013-07-09
1932447364 Grazia Oropesa Nurse Practitioner 12824 Nw 21st St, Pembroke Pines, FL 33028 2013-01-18
1548545320 Rita Galliano Speech-Language Pathologist 1261 Nw 141st Ave, Pembroke Pines, FL 33028 2011-10-12
1033429949 Paulette Paul Registered Nurse 15575 N.w. 12th Court, Pembroke Pines, FL 33028 2010-10-13
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Taxonomy Information

Taxonomy Code 207ND0101X
Grouping Allopathic & Osteopathic Physicians
Classification Dermatology
Specialization MOHS-Micrographic Surgery

Taxonomy Definition

The highly-trained surgeons that perform Mohs Micrographic Surgery are specialists both in dermatology and pathology. With their extensive knowledge of the skin and unique pathological skills, they are able to remove only diseased tissue, preserving healthy tissue and minimizing the cosmetic impact of the surgery. Mohs surgeons who belong to the American College of Mohs Surgery (ACMS) have completed a minimum of one year of fellowship training at one of the ACMS-approved training centers in the U.S.
Notes: Source: American College of Mohs Surgery, 2007 [1/1/2008: added definition, added source] Additional Resources: Additional Resources: http://www.mohscollege.org/; American Board of Dermatology, 2007. http://www.abderm.org/

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NPI Name Taxonomy Address Enumeration
1144827577 Onspot-fl LLC. Dermatology 16461 Domestic Ave, Fort Myers, FL 33912-6008 2020-10-08
1942855150 International Dermatology Research, Inc. Dermatology 8370 W Flagler St Ste 200, Miami, FL 33144-2038 2019-08-05
1154815546 Forefront Dermatology, S.c. Dermatology 7720 Us Highway 98 W Ste 240, Miramar Beach, FL 32550-7232 2018-06-19
1437517802 Total Vein and Skin LLC Dermatology 10383 Hagen Ranch Road, Ste 100, Boynton Beach, FL 33437-3732 2016-02-01
1861812851 Anand Haryani Dermatology 8745 N Us Highway 1, Sebastian, FL 32958-7524 2014-04-17
1164841797 Michael Montuno Dermatology 38135 Market Sq Ste 108, Zephyrhills, FL 33542-7505 2014-04-10
1861813719 Hillcrest Dermatology and Plastic Surgery P.a. Dermatology 733 Highway 466, Lady Lake, FL 32159-6340 2013-12-19
1922355957 Florida Medical Specialists Dermatology 4351 Cortez Rd W, Suite 101, Bradenton, FL 34210 2012-08-09
1619232501 Alliant Dermatology Pa Dermatology 8620 E County Road 466, The Villages, FL 32162-3670 2012-07-07
1114218328 Leavitt Medical Assocaittes of Florida Inc Dermatology 1426 E Bloomindale Ave, Valrico, FL 33596 2011-04-21
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Competitor

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City PEMBROKE PINES
Zip Code 33028

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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