Provider Demographics
NPI:1205147147
Name:DRS PENNER, NORRIS, ROUTMAN, PA
Entity type:Organization
Organization Name:DRS PENNER, NORRIS, ROUTMAN, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JOY
Authorized Official - Middle Name:
Authorized Official - Last Name:JALAEIKHOO
Authorized Official - Suffix:
Authorized Official - Credentials:MBA/HCM
Authorized Official - Phone:561-967-4400
Mailing Address - Street 1:5600 PGA BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33418-3900
Mailing Address - Country:US
Mailing Address - Phone:561-627-8500
Mailing Address - Fax:561-624-5885
Practice Address - Street 1:5600 PGA BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33418-3900
Practice Address - Country:US
Practice Address - Phone:561-627-8500
Practice Address - Fax:561-624-5885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-25
Last Update Date:2011-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0415890003Medicare NSC