Provider Demographics
NPI:1225483142
Name:SPINE CARE INSTITUTE OF MIAMI BEACH PA
Entity Type:Organization
Organization Name:SPINE CARE INSTITUTE OF MIAMI BEACH PA
Other - Org Name:DAN S COHEN PA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:COHEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-423-3939
Mailing Address - Street 1:4308 ALTON ROAD
Mailing Address - Street 2:SUITE 610
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33140-4559
Mailing Address - Country:US
Mailing Address - Phone:305-423-3939
Mailing Address - Fax:305-695-0711
Practice Address - Street 1:4308 ALTON ROAD #610
Practice Address - Street 2:
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33140-4559
Practice Address - Country:US
Practice Address - Phone:305-423-3939
Practice Address - Fax:305-695-0711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-28
Last Update Date:2016-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0051493207X00000X
FLPA9104491363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE21387Medicare UPIN