Provider Demographics
NPI:1336250075
Name:FAMILY FOOT AND ANKLE OF BOCA RATON P A
Entity Type:Organization
Organization Name:FAMILY FOOT AND ANKLE OF BOCA RATON P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:BOVARNICK
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:561-241-7763
Mailing Address - Street 1:6642 NW 25TH CT
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33496-2016
Mailing Address - Country:US
Mailing Address - Phone:561-241-7763
Mailing Address - Fax:561-241-7763
Practice Address - Street 1:5458 TOWN CENTER RD
Practice Address - Street 2:SUITE 23 MED-PLEX BLDG.
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486-1089
Practice Address - Country:US
Practice Address - Phone:561-391-4142
Practice Address - Fax:561-391-4102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO2831174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK2694Medicare ID - Type Unspecified
FLU85449Medicare UPIN
FL4212470001Medicare NSC