Basic Information
| Provider Information | |||||||||
| NPI: | 1063187771 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SOUTH FLORIDA SURGICAL SPECIALISTS LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3001 CORAL HILLS DR STE 320 | ||||||||
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| City: | CORAL SPRINGS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330654172 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9542134741 | ||||||||
| FaxNumber: | 9547552209 | ||||||||
| Practice Location | |||||||||
| Address1: | 2825 N STATE ROAD 7 STE 305 | ||||||||
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| City: | MARGATE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330635737 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2024159235 | ||||||||
| FaxNumber: | 7542057987 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/13/2021 | ||||||||
| LastUpdateDate: | 08/13/2021 | ||||||||
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| AuthorizedOfficialLastName: | GULAREK | ||||||||
| AuthorizedOfficialFirstName: | JUSTIN | ||||||||
| AuthorizedOfficialMiddleName: | C | ||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 9542134741 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | MBA | ||||||||
| NPICertificationDate: | 07/21/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.