Provider Demographics
NPI:1922366699
Name:CENTER FOR ORTHOPEDIC AND SPINAL SURGERY LLC
Entity Type:Organization
Organization Name:CENTER FOR ORTHOPEDIC AND SPINAL SURGERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:SIMON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-845-7078
Mailing Address - Street 1:8895 N MILITARY TRL
Mailing Address - Street 2:SUITE# 201-E
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33410-6220
Mailing Address - Country:US
Mailing Address - Phone:561-845-7078
Mailing Address - Fax:
Practice Address - Street 1:701 NORTHLAKE BLVD STE 201
Practice Address - Street 2:
Practice Address - City:NORTH PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33408-5215
Practice Address - Country:US
Practice Address - Phone:561-845-7078
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-01
Last Update Date:2019-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0073142174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty