Provider Demographics
NPI:1184796245
Name:PALM BEACH ORTHOPAEDIC INSTITUTE PA
Entity type:Organization
Organization Name:PALM BEACH ORTHOPAEDIC INSTITUTE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PRIYA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHANDRADAT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-694-7776
Mailing Address - Street 1:4215 BURNS RD
Mailing Address - Street 2:200
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-4625
Mailing Address - Country:US
Mailing Address - Phone:561-694-7776
Mailing Address - Fax:561-694-3099
Practice Address - Street 1:4215 BURNS RD
Practice Address - Street 2:100
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-4627
Practice Address - Country:US
Practice Address - Phone:561-694-7776
Practice Address - Fax:561-694-3099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL251791400Medicaid
FL33380OtherMEDICARE PTAN
FL33380OtherMEDICARE PTAN