Provider Demographics
NPI:1659490985
Name:NEUROSCIENCE CENTER OF BOCA RATON INC
Entity Type:Organization
Organization Name:NEUROSCIENCE CENTER OF BOCA RATON INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:S
Authorized Official - Last Name:BAILYN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-392-8533
Mailing Address - Street 1:3848 FAU BLVD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-6437
Mailing Address - Country:US
Mailing Address - Phone:561-392-8533
Mailing Address - Fax:
Practice Address - Street 1:3848 FAU BLVD
Practice Address - Street 2:SUITE 205
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-6437
Practice Address - Country:US
Practice Address - Phone:561-392-8533
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL317162084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty