Provider Demographics
NPI:1992365472
Name:NEUROSPORT LLC
Entity Type:Organization
Organization Name:NEUROSPORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF MEDICAL OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:KANTOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-687-7879
Mailing Address - Street 1:378 HILLSBORO TECHNOLOGY DR
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33441-1836
Mailing Address - Country:US
Mailing Address - Phone:954-949-2345
Mailing Address - Fax:954-949-2346
Practice Address - Street 1:378 HILLSBORO TECHNOLOGY DR
Practice Address - Street 2:
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33441-1836
Practice Address - Country:US
Practice Address - Phone:954-949-2345
Practice Address - Fax:954-949-2346
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-18
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty