Provider Demographics
NPI:1568869113
Name:BLACKSTONE HAND CENTER, LLC
Entity Type:Organization
Organization Name:BLACKSTONE HAND CENTER, LLC
Other - Org Name:MELBOURNE HAND CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:MOYLES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:321-500-4263
Mailing Address - Street 1:2010 WEST EAU GALLIE BLVD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935
Mailing Address - Country:US
Mailing Address - Phone:305-609-7688
Mailing Address - Fax:
Practice Address - Street 1:2010 WEST EAU GALLIE BLVD
Practice Address - Street 2:SUITE 104
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935
Practice Address - Country:US
Practice Address - Phone:305-609-7688
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-25
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME113873207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand SurgeryGroup - Single Specialty