Provider Demographics
NPI:1225476328
Name:EIDELSON SPINE INC
Entity Type:Organization
Organization Name:EIDELSON SPINE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEWART
Authorized Official - Middle Name:G
Authorized Official - Last Name:EIDELSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-716-1560
Mailing Address - Street 1:15300 JOG RD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33446-2162
Mailing Address - Country:US
Mailing Address - Phone:561-742-5959
Mailing Address - Fax:561-734-2226
Practice Address - Street 1:1900 GARDEN RD
Practice Address - Street 2:STE.120
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-5373
Practice Address - Country:US
Practice Address - Phone:831-657-0111
Practice Address - Fax:831-656-1202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-11
Last Update Date:2015-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG89325207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Single Specialty