Provider Demographics
NPI:1609147347
Name:NEUROSURGICAL SPECIALISTS LLC
Entity Type:Organization
Organization Name:NEUROSURGICAL SPECIALISTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TERRI
Authorized Official - Middle Name:
Authorized Official - Last Name:PETRUSKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-307-1006
Mailing Address - Street 1:4521 PGA BLVD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33418-3997
Mailing Address - Country:US
Mailing Address - Phone:561-307-1006
Mailing Address - Fax:
Practice Address - Street 1:927 45TH ST
Practice Address - Street 2:SUITE 204
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407-2450
Practice Address - Country:US
Practice Address - Phone:561-307-1006
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-25
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty