Provider Demographics
NPI:1558608018
Name:SPIRITUAL PYSCHIATRY PC
Entity Type:Organization
Organization Name:SPIRITUAL PYSCHIATRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEONID
Authorized Official - Middle Name:
Authorized Official - Last Name:ALTSHULER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:347-782-7247
Mailing Address - Street 1:PO BOX 811523
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33481-1523
Mailing Address - Country:US
Mailing Address - Phone:347-782-7247
Mailing Address - Fax:954-200-7814
Practice Address - Street 1:2803 E COMMERCIAL BLVD
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-4205
Practice Address - Country:US
Practice Address - Phone:347-782-7247
Practice Address - Fax:954-200-7814
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-03
Last Update Date:2013-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1040942084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty