Provider Demographics
NPI:1437341070
Name:NEUROMUSCULAR ASSOCIATES INC
Entity Type:Organization
Organization Name:NEUROMUSCULAR ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:PENNELL
Authorized Official - Suffix:
Authorized Official - Credentials:AC PHYS, LMT
Authorized Official - Phone:954-993-7502
Mailing Address - Street 1:418 N RIVER DR
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33441-2043
Mailing Address - Country:US
Mailing Address - Phone:954-993-7502
Mailing Address - Fax:
Practice Address - Street 1:4701 N FED HWY
Practice Address - Street 2:SUITE # 311, BOX 9-A
Practice Address - City:LIGHTHOUSE POINT
Practice Address - State:FL
Practice Address - Zip Code:33064
Practice Address - Country:US
Practice Address - Phone:954-993-7502
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-17
Last Update Date:2007-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP215261QH0100X
FLMA37160261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC2425OtherBLUE CROSS BLUE SHIELD
FLC0079OtherBLUE CROSS BLUE SHIELD