Provider Demographics
NPI:1073940151
Name:JENSEN BEACH FAMILY PRACTICE, INC
Entity Type:Organization
Organization Name:JENSEN BEACH FAMILY PRACTICE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:ADELBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:772-692-8082
Mailing Address - Street 1:3405 NW FEDERAL HWY
Mailing Address - Street 2:
Mailing Address - City:JENSEN BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:34957-4439
Mailing Address - Country:US
Mailing Address - Phone:772-692-8082
Mailing Address - Fax:772-232-9211
Practice Address - Street 1:3405 NW FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:JENSEN BEACH
Practice Address - State:FL
Practice Address - Zip Code:34957-4439
Practice Address - Country:US
Practice Address - Phone:772-692-8082
Practice Address - Fax:772-232-9211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-03
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME68270207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty