1891920369 NPI number — OBGYN SPECIALISTS OF THE PALM BEACHES PA

Table of content: (NPI 1891920369)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891920369 NPI number — OBGYN SPECIALISTS OF THE PALM BEACHES PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OBGYN SPECIALISTS OF THE PALM BEACHES PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1891920369
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/25/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
770 NORTHPOINT PKWY STE 102
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST PALM BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33407-1901
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-275-7604
Provider Business Mailing Address Fax Number:
561-802-5385

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
927 45TH ST
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
WEST PALM BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33407-2450
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-881-9650
Provider Business Practice Location Address Fax Number:
561-881-9908
Provider Enumeration Date:
05/27/2009

Additional Information

Authorized Official

Authorized Official Last Name:
BURIGO
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
561-275-7509

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 372700914 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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