Provider Demographics
NPI:1821466715
Name:ADVANCED CANCER SURGERY AND DIGESTIVE HEALTH LLC
Entity Type:Organization
Organization Name:ADVANCED CANCER SURGERY AND DIGESTIVE HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:J
Authorized Official - Last Name:DALESSIO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-536-4430
Mailing Address - Street 1:9868 S. STATE ROAD 7
Mailing Address - Street 2:SUITE 300
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33472
Mailing Address - Country:US
Mailing Address - Phone:561-536-4430
Mailing Address - Fax:561-303-2142
Practice Address - Street 1:9868 S. STATE ROAD 7
Practice Address - Street 2:SUITE 300
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33472
Practice Address - Country:US
Practice Address - Phone:561-536-4430
Practice Address - Fax:561-303-2142
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-09
Last Update Date:2015-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME96070208600000X, 2086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical OncologyGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL138738Medicare UPIN