Provider Demographics
NPI:1376859744
Name:DANIEL IGAL NUCHOVICH,M.D., P.A.
Entity Type:Organization
Organization Name:DANIEL IGAL NUCHOVICH,M.D., P.A.
Other - Org Name:JUPITER GARDENS MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:RN/ OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANA
Authorized Official - Middle Name:I
Authorized Official - Last Name:NUCHOVICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-746-2033
Mailing Address - Street 1:175 TONEY PENNA DR
Mailing Address - Street 2:101
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-5755
Mailing Address - Country:US
Mailing Address - Phone:561-746-2033
Mailing Address - Fax:561-744-5349
Practice Address - Street 1:175 TONEY PENNA DR
Practice Address - Street 2:STE 101
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-5755
Practice Address - Country:US
Practice Address - Phone:561-746-2033
Practice Address - Fax:561-744-5349
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-24
Last Update Date:2011-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 0053694261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC52001Medicare UPIN
FL09272Medicare PIN