Provider Demographics
NPI:1205014776
Name:ORTHOPAEDIC ASSOCIATES OF SOUTH BROWARD PA
Entity Type:Organization
Organization Name:ORTHOPAEDIC ASSOCIATES OF SOUTH BROWARD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WARREN
Authorized Official - Middle Name:
Authorized Official - Last Name:GROSSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-961-3500
Mailing Address - Street 1:1150 N 35TH AVE
Mailing Address - Street 2:SUITE 390
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-5424
Mailing Address - Country:US
Mailing Address - Phone:954-961-3500
Mailing Address - Fax:954-961-1835
Practice Address - Street 1:1 SW 129TH AVE
Practice Address - Street 2:SUITE 401
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33027-1761
Practice Address - Country:US
Practice Address - Phone:954-961-3500
Practice Address - Fax:954-961-1835
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-06
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME62041174400000X
FLPO 3022213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty