Provider Demographics
NPI:1164654612
Name:BOCACARE EAST INC
Entity Type:Organization
Organization Name:BOCACARE EAST INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:J
Authorized Official - Last Name:FEDELE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-995-7800
Mailing Address - Street 1:1001 NW 13TH STREET
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33486
Mailing Address - Country:US
Mailing Address - Phone:561-995-7800
Mailing Address - Fax:561-394-3334
Practice Address - Street 1:1001 NW 13TH STREET
Practice Address - Street 2:SUITE 201
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486
Practice Address - Country:US
Practice Address - Phone:561-995-7800
Practice Address - Fax:561-394-3334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-18
Last Update Date:2009-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME50287207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL07191OtherBC