Provider Demographics
NPI:1003205196
Name:PALM BEACH GARDENS REGIONAL SURGERY CENTER LLC
Entity Type:Organization
Organization Name:PALM BEACH GARDENS REGIONAL SURGERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ISAAC
Authorized Official - Middle Name:
Authorized Official - Last Name:VERBUKH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-392-3341
Mailing Address - Street 1:398 CAMINO GARDENS BLVD
Mailing Address - Street 2:102
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33432-5827
Mailing Address - Country:US
Mailing Address - Phone:561-392-3341
Mailing Address - Fax:561-392-3341
Practice Address - Street 1:11030 RCA CENTER DR
Practice Address - Street 2:3001
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-4276
Practice Address - Country:US
Practice Address - Phone:561-392-3341
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-13
Last Update Date:2015-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical