Provider Demographics
NPI:1821284316
Name:PALM BEACH PODIATRIC CENTER
Entity Type:Organization
Organization Name:PALM BEACH PODIATRIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:CARL
Authorized Official - Last Name:LERNER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:561-641-7884
Mailing Address - Street 1:10115 W FOREST HILL BLVD
Mailing Address - Street 2:SUITE 302
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-3105
Mailing Address - Country:US
Mailing Address - Phone:561-641-7884
Mailing Address - Fax:561-641-0440
Practice Address - Street 1:10115 W FOREST HILL BLVD
Practice Address - Street 2:SUITE 302
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-3105
Practice Address - Country:US
Practice Address - Phone:561-641-7884
Practice Address - Fax:561-641-0440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-19
Last Update Date:2009-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPL1852213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDG1880OtherRAILROAD MEDICARE
FL5186590001Medicare NSC
FLT91414Medicare UPIN
FLK5759Medicare PIN