Provider Demographics
NPI:1427231562
Name:CORAL WAY MEDICAL CENTER INC
Entity Type:Organization
Organization Name:CORAL WAY MEDICAL CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:LUBETSKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:772-337-4430
Mailing Address - Street 1:1940 SE PORT ST LUCIE BLVD
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-5510
Mailing Address - Country:US
Mailing Address - Phone:772-337-4430
Mailing Address - Fax:772-337-4431
Practice Address - Street 1:1940 SE PORT ST LUCIE BLVD
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-5510
Practice Address - Country:US
Practice Address - Phone:772-337-4430
Practice Address - Fax:772-337-4431
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-12
Last Update Date:2009-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty