Provider Demographics
NPI:1316228141
Name:DELORENZI ORTHOPAEDIC CENTER PA
Entity Type:Organization
Organization Name:DELORENZI ORTHOPAEDIC CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:J
Authorized Official - Last Name:DELORENZI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:321-622-8622
Mailing Address - Street 1:7000 SPYGLASS CT
Mailing Address - Street 2:SUITE 220
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940-8288
Mailing Address - Country:US
Mailing Address - Phone:321-622-8622
Mailing Address - Fax:321-622-8624
Practice Address - Street 1:7000 SPYGLASS CT
Practice Address - Street 2:SUITE 220
Practice Address - City:VIERA
Practice Address - State:FL
Practice Address - Zip Code:32940
Practice Address - Country:US
Practice Address - Phone:321-622-8622
Practice Address - Fax:321-622-8624
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-07
Last Update Date:2019-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FT345AOtherMEDICARE PTAN
FL6655870001Medicare NSC