Provider Demographics
NPI:1568642619
Name:PHYSICIAN SURGICAL NETWORK INC.
Entity Type:Organization
Organization Name:PHYSICIAN SURGICAL NETWORK INC.
Other - Org Name:CENTRAL FLORIDA ARTHRITIS AND OSTEOPOROSIS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:
Authorized Official - Last Name:GITMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-248-3422
Mailing Address - Street 1:831 CORAL RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33071-4180
Mailing Address - Country:US
Mailing Address - Phone:954-248-3422
Mailing Address - Fax:
Practice Address - Street 1:1020 W OAK ST
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-4113
Practice Address - Country:US
Practice Address - Phone:407-870-1579
Practice Address - Fax:407-870-2353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-06
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL09685ZMedicare PIN