Provider Demographics
NPI:1588618037
Name:NEUROSURGICAL CONSULTANTS OF FL, PA
Entity Type:Organization
Organization Name:NEUROSURGICAL CONSULTANTS OF FL, PA
Other - Org Name:NEUROSPINE INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:L
Authorized Official - Last Name:MASSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-649-8585
Mailing Address - Street 1:2706 REW CIR
Mailing Address - Street 2:
Mailing Address - City:OCOEE
Mailing Address - State:FL
Mailing Address - Zip Code:34761-4215
Mailing Address - Country:US
Mailing Address - Phone:407-649-8585
Mailing Address - Fax:407-654-0151
Practice Address - Street 1:2706 REW CIR
Practice Address - Street 2:
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-4215
Practice Address - Country:US
Practice Address - Phone:407-649-8585
Practice Address - Fax:407-654-0151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0063598207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL261301OtherAVMED
FL46474OtherBLUE CROSS BLUE SHIELD
FL261301OtherAVMED
FL46474OtherBLUE CROSS BLUE SHIELD
FL45184Medicare ID - Type UnspecifiedGROUP NUMBER