Provider Demographics
NPI:1407210669
Name:EAST BOCA RATON PHYSICIANS GROUP, LLC
Entity Type:Organization
Organization Name:EAST BOCA RATON PHYSICIANS GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:
Authorized Official - Last Name:FRYDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:561-279-5221
Mailing Address - Street 1:2234 N FEDERAL HWY
Mailing Address - Street 2:SUITE 321
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-7710
Mailing Address - Country:US
Mailing Address - Phone:561-279-5221
Mailing Address - Fax:
Practice Address - Street 1:2234 N FEDERAL HWY
Practice Address - Street 2:SUITE 321
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-7710
Practice Address - Country:US
Practice Address - Phone:561-279-5221
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-13
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup PsychotherapyGroup - Multi-Specialty