Provider Demographics
NPI:1972933745
Name:PERINATAL SPECIALISTS OF THE PALM BEACHES
Entity Type:Organization
Organization Name:PERINATAL SPECIALISTS OF THE PALM BEACHES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:BURIGO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-275-7604
Mailing Address - Street 1:2979 PGA BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-2911
Mailing Address - Country:US
Mailing Address - Phone:561-275-7604
Mailing Address - Fax:561-802-5385
Practice Address - Street 1:1545 SE PALM CT
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-4914
Practice Address - Country:US
Practice Address - Phone:772-288-9929
Practice Address - Fax:772-288-9931
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OB/GYN SPECIALISTS OF THE PALM BEACHES PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-11-15
Last Update Date:2014-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME64730207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL372700916Medicaid