Basic Information
| Provider Information | |||||||||
| NPI: | 1548272974 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SOUTH PALM BEACH MEDICAL ASSOCIATES, PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 22380 DORADO DR | ||||||||
| Address2: | |||||||||
| City: | BOCA RATON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334334962 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5613029445 | ||||||||
| FaxNumber: | 5617603999 | ||||||||
| Practice Location | |||||||||
| Address1: | 1130 NW 15TH ST | ||||||||
| Address2: | |||||||||
| City: | BOCA RATON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334861333 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5613946282 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/13/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | SKOCZYLAS | ||||||||
| AuthorizedOfficialFirstName: | LEOR | ||||||||
| AuthorizedOfficialMiddleName: | JOSEPH | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5613029445 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | ME93589 | FL | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.