Basic Information
| Provider Information | |||||||||
| NPI: | 1851979066 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SOUTH FLORIDA SPINAL NEUROSURGERY ASSOCIATES, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 854 AZALEA ST | ||||||||
| Address2: | |||||||||
| City: | BOCA RATON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334863536 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5037068272 | ||||||||
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| Practice Location | |||||||||
| Address1: | 7805 NW BEACON SQUARE BLVD | ||||||||
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| City: | BOCA RATON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334871395 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8009644395 | ||||||||
| FaxNumber: | 5613256072 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/30/2021 | ||||||||
| LastUpdateDate: | 03/30/2021 | ||||||||
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| AuthorizedOfficialLastName: | OPPENHEIMER | ||||||||
| AuthorizedOfficialFirstName: | JEFFREY | ||||||||
| AuthorizedOfficialMiddleName: | HARRY | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 8009644395 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 03/30/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207T00000X | N | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Neurological Surgery | 332B00000X | Y | Suppliers | Durable Medical Equipment & Medical Supplies |
No ID Information.