Provider Demographics
NPI:1396911277
Name:HOLLYWOOD-CORAL SPRINGS PODIATRY PA
Entity type:Organization
Organization Name:HOLLYWOOD-CORAL SPRINGS PODIATRY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MGR
Authorized Official - Prefix:
Authorized Official - First Name:JEANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:DRUZBIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-753-6766
Mailing Address - Street 1:8116 WILES RD
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33067-2061
Mailing Address - Country:US
Mailing Address - Phone:954-753-6766
Mailing Address - Fax:
Practice Address - Street 1:4420 SHERIDAN ST
Practice Address - Street 2:SUITE C
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-3552
Practice Address - Country:US
Practice Address - Phone:954-989-8850
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOLLYWOOD-CORAL SPRINGS PODIATRY, PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-05-01
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLP01870213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
5738410001Medicare NSC