Provider Demographics
NPI:1326540295
Name:SOUTH FLORIDA SPINAL NEUROSURGERY ASSOCIATES LLC
Entity Type:Organization
Organization Name:SOUTH FLORIDA SPINAL NEUROSURGERY ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:HARRY
Authorized Official - Last Name:OPPENHEIMER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:800-964-4395
Mailing Address - Street 1:1770 S OCEAN BLVD APT 201
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33062-7802
Mailing Address - Country:US
Mailing Address - Phone:503-706-8272
Mailing Address - Fax:
Practice Address - Street 1:7805 NW BEACON SQUARE BLVD STE 103
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33487-1396
Practice Address - Country:US
Practice Address - Phone:800-964-4395
Practice Address - Fax:954-634-4293
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-06
Last Update Date:2023-02-13
Deactivation Date:2021-03-30
Deactivation Code:
Reactivation Date:2022-03-09
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME60083OtherLICENSE
FLB5SXNOtherBCBS