Provider Demographics
NPI:1043242472
Name:FLORIDA NEUROLOGIC ASSOCIATES PA
Entity Type:Organization
Organization Name:FLORIDA NEUROLOGIC ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEFFERY
Authorized Official - Middle Name:B
Authorized Official - Last Name:GELBLUM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-936-9393
Mailing Address - Street 1:21150 BISCAYNE BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-1226
Mailing Address - Country:US
Mailing Address - Phone:305-936-9393
Mailing Address - Fax:305-936-9650
Practice Address - Street 1:21150 BISCAYNE BLVD STE 201
Practice Address - Street 2:
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-1231
Practice Address - Country:US
Practice Address - Phone:305-936-9393
Practice Address - Fax:305-936-9650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL33728Medicare PIN
FL33728AMedicare PIN