Provider Demographics
NPI:1679862874
Name:INNOVATIVE ORTHOPEDICS OF FLORIDA LLC
Entity Type:Organization
Organization Name:INNOVATIVE ORTHOPEDICS OF FLORIDA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:J
Authorized Official - Last Name:SILVERBERG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:772-337-5511
Mailing Address - Street 1:1701 SE HILLMOOR DR
Mailing Address - Street 2:SUITE A1
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-7552
Mailing Address - Country:US
Mailing Address - Phone:772-337-5511
Mailing Address - Fax:772-335-7841
Practice Address - Street 1:1701 SE HILLMOOR DR
Practice Address - Street 2:SUITE A1
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-7552
Practice Address - Country:US
Practice Address - Phone:772-337-5511
Practice Address - Fax:772-335-7841
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-29
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME64267207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty