Provider Demographics
NPI:1093991622
Name:NORTH BROWARD NEUROSURGERY INC
Entity Type:Organization
Organization Name:NORTH BROWARD NEUROSURGERY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:FOLTZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-545-4045
Mailing Address - Street 1:1600 S FEDERAL HWY
Mailing Address - Street 2:SUITE 640
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33062-7500
Mailing Address - Country:US
Mailing Address - Phone:954-545-4045
Mailing Address - Fax:954-545-4614
Practice Address - Street 1:1600 S FEDERAL HWY
Practice Address - Street 2:SUITE 640
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33062-7500
Practice Address - Country:US
Practice Address - Phone:954-545-4045
Practice Address - Fax:954-545-4614
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-14
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0067422174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK1058Medicare PIN