Provider Demographics
NPI:1508992777
Name:DIVERSIFIED SPECIALTIES
Entity Type:Organization
Organization Name:DIVERSIFIED SPECIALTIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:MARTIN
Authorized Official - Last Name:NIGRO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:772-664-3668
Mailing Address - Street 1:8000 RON BEATTY BLVD
Mailing Address - Street 2:SUITE A-3
Mailing Address - City:MICCO
Mailing Address - State:FL
Mailing Address - Zip Code:32976-7474
Mailing Address - Country:US
Mailing Address - Phone:772-664-3668
Mailing Address - Fax:772-664-3343
Practice Address - Street 1:8000 RON BEATTY BLVD
Practice Address - Street 2:SUITE A-3
Practice Address - City:MICCO
Practice Address - State:FL
Practice Address - Zip Code:32976-7474
Practice Address - Country:US
Practice Address - Phone:772-664-3668
Practice Address - Fax:772-664-3343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-24
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL5341480001Medicare NSC