Provider Demographics
NPI:1598057671
Name:CENTER FOR BONE & JOINT SURGERY OF THE PALM BEACHES, P.A.
Entity Type:Organization
Organization Name:CENTER FOR BONE & JOINT SURGERY OF THE PALM BEACHES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HARVEY
Authorized Official - Middle Name:
Authorized Official - Last Name:MONTIJO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-798-6600
Mailing Address - Street 1:10131 FOREST HILL BLVD
Mailing Address - Street 2:STE 230
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-6109
Mailing Address - Country:US
Mailing Address - Phone:561-803-8616
Mailing Address - Fax:561-613-1956
Practice Address - Street 1:10111 FOREST HILL BLVD
Practice Address - Street 2:STE 151
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-6141
Practice Address - Country:US
Practice Address - Phone:561-798-6600
Practice Address - Fax:561-615-1956
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTER FOR BONE & JOINT SURGERY OF THE PALM BEACHES, P.A.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-05-09
Last Update Date:2022-08-29
Deactivation Date:2018-07-25
Deactivation Code:
Reactivation Date:2018-08-17
Provider Licenses
StateLicense IDTaxonomies
FLBS8736968207X00000X
207X00000X
FLME91084207XX0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No207XX0801XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic TraumaGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL274416300Medicaid
FLI36832Medicare UPIN