Provider Demographics
NPI:1598726986
Name:PODIATRY ASSOCIATES OF PALM BEACH GARDENS INC
Entity Type:Organization
Organization Name:PODIATRY ASSOCIATES OF PALM BEACH GARDENS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ORLANDO
Authorized Official - Middle Name:A
Authorized Official - Last Name:CEDENO
Authorized Official - Suffix:JR
Authorized Official - Credentials:DPM
Authorized Official - Phone:561-624-4800
Mailing Address - Street 1:4601 MILITARY TRAIL
Mailing Address - Street 2:SUITE 202
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-4835
Mailing Address - Country:US
Mailing Address - Phone:561-624-4800
Mailing Address - Fax:561-624-5206
Practice Address - Street 1:4601 MILITARY TRAIL
Practice Address - Street 2:SUITE 202
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-4835
Practice Address - Country:US
Practice Address - Phone:561-624-4800
Practice Address - Fax:561-624-5206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-28
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO1951213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDC0438OtherRAIL ROAD MEDICARE
FL5388080001Medicare NSC