Provider Demographics
NPI:1831292465
Name:BOYNTON BEACH REAL ESTATE LLC
Entity Type:Organization
Organization Name:BOYNTON BEACH REAL ESTATE LLC
Other - Org Name:BOYNTON BEACH CANCER CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KISHORE
Authorized Official - Middle Name:K
Authorized Official - Last Name:DASS
Authorized Official - Suffix:
Authorized Official - Credentials:DR
Authorized Official - Phone:561-737-2339
Mailing Address - Street 1:2301 WEST WOOLBRIGHT RD
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33426
Mailing Address - Country:US
Mailing Address - Phone:561-737-2339
Mailing Address - Fax:561-737-2521
Practice Address - Street 1:2301 WEST WOOLBRIGHT RD
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33426
Practice Address - Country:US
Practice Address - Phone:561-737-2339
Practice Address - Fax:561-737-2521
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
17106OtherBCBS DR HAN
23468OtherBCBS DR DASS
61186XOtherBCBS DR SHERRY
D65250Medicare UPIN
E97834Medicare UPIN
17106OtherBCBS DR HAN