Provider Demographics
NPI:1134202740
Name:PRESIDENTIAL SURGICENTER, INC.
Entity type:Organization
Organization Name:PRESIDENTIAL SURGICENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAY
Authorized Official - Middle Name:S
Authorized Official - Last Name:WALLSHEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-689-7255
Mailing Address - Street 1:1501 PRESIDENTIAL WAY, SUITE #9
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401
Mailing Address - Country:US
Mailing Address - Phone:561-689-7255
Mailing Address - Fax:561-683-7342
Practice Address - Street 1:1501 PRESIDENTIAL WAY
Practice Address - Street 2:SUITE #9
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401
Practice Address - Country:US
Practice Address - Phone:561-689-7255
Practice Address - Fax:561-683-7342
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2018-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL921261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL490000914OtherRAILROAD MEDICARE
FL079229200Medicaid
FL61COtherBC BS FL
FL61COtherBC BS FL