Provider Demographics
NPI:1144787243
Name:NOVA ORTHO AND SPINE, PLLC
Entity Type:Organization
Organization Name:NOVA ORTHO AND SPINE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:D
Authorized Official - Last Name:BRODSKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:772-260-7023
Mailing Address - Street 1:1903 S 25TH ST STE 103
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34947-4740
Mailing Address - Country:US
Mailing Address - Phone:772-529-4573
Mailing Address - Fax:772-410-4062
Practice Address - Street 1:1903 S 25TH ST STE 103
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34947-4740
Practice Address - Country:US
Practice Address - Phone:772-529-4573
Practice Address - Fax:772-410-4062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-25
Last Update Date:2019-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center