Basic Information
| Provider Information | |||||||||
| NPI: | 1326540295 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SOUTH FLORIDA SPINAL NEUROSURGERY ASSOCIATES LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 845 AZALEA ST | ||||||||
| Address2: | |||||||||
| City: | BOCA RATON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33486 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5037068272 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6280 W SAMPLE RD STE 203 | ||||||||
| Address2: | |||||||||
| City: | CORAL SPRINGS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330673173 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5613223588 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/06/2018 | ||||||||
| LastUpdateDate: | 03/09/2022 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | 03/30/2021 | ||||||||
| NPIReactivationDate: | 03/09/2022 | ||||||||
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| AuthorizedOfficialLastName: | OPPENHEIMER | ||||||||
| AuthorizedOfficialFirstName: | JEFFREY | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO/PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5037068272 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 03/09/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207T00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Neurological Surgery |
No ID Information.