Provider Demographics
NPI:1972509644
Name:SURFSIDE PAIN CONTROL CENTER
Entity Type:Organization
Organization Name:SURFSIDE PAIN CONTROL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:VERA
Authorized Official - Middle Name:
Authorized Official - Last Name:VASERSHTEYN
Authorized Official - Suffix:
Authorized Official - Credentials:AP
Authorized Official - Phone:305-861-0078
Mailing Address - Street 1:260 95TH ST
Mailing Address - Street 2:STE 206
Mailing Address - City:SURFSIDE
Mailing Address - State:FL
Mailing Address - Zip Code:33154-2807
Mailing Address - Country:US
Mailing Address - Phone:305-861-0078
Mailing Address - Fax:305-993-3828
Practice Address - Street 1:260 95TH ST
Practice Address - Street 2:STE 206
Practice Address - City:SURFSIDE
Practice Address - State:FL
Practice Address - Zip Code:33154-2807
Practice Address - Country:US
Practice Address - Phone:305-861-0078
Practice Address - Fax:305-993-3828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME81951207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL39373Medicare ID - Type Unspecified