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JOSEPH FANFAN JR MD PA
NPI 1689059453
Clinic/Center in Wilton Manors, FL

Active since July 22, 2015
2630 N ANDREWS AVE, WILTON MANORS, FL 33311(954) 525-4900(954) 396-3110 Get Directions Write a Review

NPPES record last updated: May 9, 2016. Verified against the NPPES registry weekly; last sync: November 01, 2026.

Record update history: May 9, 2016, Feb 11, 2016 (2 updates tracked since 2016).

About Joseph Fanfan Jr Md Pa NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

JOSEPH FANFAN JR MD PA (NPI 1689059453) is a healthcare organization registered as a clinic/center in Wilton Manors, Florida and active in the NPI registry since July 2015. The organization lists Joseph Fanfan, President, as its authorized official.

NPPES Registry Identity

NPI1689059453
Entity TypeOrganization
Primary Taxonomy261Q00000X
Legal Business NameLA CLINIQUE 300 INC
Location Address2630 N ANDREWS AVEWilton Manors, FL 33311-2550
Mailing Address2630 N Andrews AveWilton Manors, FL 33311-2550 · (954) 525-4900 · Fax (954) 396-3110
Phone(954) 525-4900
Fax(954) 396-3110
Organization SubpartYesParent: Joseph Fanfan Jr Md Pa
Authorized OfficialJoseph FanfanPresident · (954) 525-4900
Enumeration DateJuly 22, 2015
Last NPPES UpdateMay 9, 20162 updates tracked since enumeration
✔ NPI 1689059453 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/CenterAmbulatory Health Care Facilities
Taxonomy Code261Q00000X
License✔ Licensed in FL · ME43065
Definition
A facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health).
2630 N ANDREWS AVE, Wilton Manors, FL 33311
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Other Names 1

Doing Business AsJoseph Fanfan Jr Md Pa

Other Identifiers 3

Medicaid068166100FL
Medicare PIN94236FL
Medicare UPIND63170FL

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Joseph Fanfan Jr Md Pa is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 1 clinician reassigns Medicare billing to Joseph Fanfan Jr MD PA, which bills Medicare for the services this clinician delivers.

Clinician (1)

Joseph Fanfan, M.D.
General Practice
NPI 1265608616
2630N ANDREWS AVE
Wilton Manors, FL 33311
(954) 525-4900
✔ PECOSSame address

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is La Clinique 300 Inc's NPI number?

The NPI number for La Clinique 300 Inc is 1689059453. It was assigned to this organization in the NPPES registry on July 22, 2015. The provider is doing business as Joseph Fanfan Jr MD PA.

Where is La Clinique 300 Inc located?

La Clinique 300 Inc is located at 2630 N Andrews Ave, Wilton Manors, FL 33311. The listed phone number is (954) 525-4900.

What is La Clinique 300 Inc's specialty?

The primary specialty registered for this NPI is Clinic/Center with taxonomy code 261Q00000X.

Is La Clinique 300 Inc enrolled in Medicare?

Yes. La Clinique 300 Inc is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through La Clinique 300 Inc?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (General Practice) reassigns their Medicare billing to La Clinique 300 Inc. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

When was this NPI record last updated?

The NPPES record for La Clinique 300 Inc was last updated on May 9, 2016. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.