Provider Demographics
NPI:1083676035
Name:BOCA RATON NEUROLOGIC ASSOCIATES PA
Entity Type:Organization
Organization Name:BOCA RATON NEUROLOGIC ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:R
Authorized Official - Last Name:KASTIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-338-8484
Mailing Address - Street 1:1050 NW 15TH ST
Mailing Address - Street 2:SUITE 216-A
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33486-1375
Mailing Address - Country:US
Mailing Address - Phone:561-338-8484
Mailing Address - Fax:561-338-8492
Practice Address - Street 1:1050 NW 15TH ST
Practice Address - Street 2:SUITE 216-A
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486-1375
Practice Address - Country:US
Practice Address - Phone:561-338-8484
Practice Address - Fax:561-338-8492
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-05
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 661132084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK1546Medicare ID - Type Unspecified